Summary
Overview
Work History
Education
Skills
HIGHLIGHTS & ACCOMPLISHMENTS
Timeline
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TIA WHITE

Lake Wales,FL

Summary

Results-driven and detail-oriented healthcare operations professional with over 8 years of progressive experience in claims adjudication, medical billing, pharmacy prior authorization, and insurance verification. Proven track record in training, quality assurance, and claims analysis, with a focus on efficiency, compliance, and team success. Adept at streamlining workflows, mentoring peers, and leveraging data to drive improvements in both individual and team performance. Recognized for leadership potential and the ability to adapt across remote environments while maintaining HIPAA compliance and exceeding performance metrics.

Overview

10
10
years of professional experience

Work History

Senior Enrollment / Medical Billing Specialist

Cigna
07.2024 - Current
  • - Analyzing claim trends and resolving payment issues through research and payer engagement
  • - Processed complex EOB discrepancies, ensuring accurate billing and timely collections
  • - Supported training of new staff in billing systems and compliance protocols
  • - Collaborated with insurance providers and internal departments to reduce claim denials

Pharmacy Prior Authorization Specialist

Cigna
09.2023 - 07.2024
  • - Managed high call volumes while resolving drug coverage issues with urgency and accuracy
  • - Verified benefit eligibility and handled escalated authorization cases with precision
  • - Created documentation to support team training and reference

Insurance Verification Specialist

GEICO
09.2022 - 09.2023
  • - Reviewed complex policy and coverage details to reduce claim handling errors
  • - Strengthened interdepartmental coordination to accelerate claim resolution
  • - Delivered empathetic service while maintaining compliance and efficiency standards

Medical Claims Representative

Kaiser Permanente
02.2020 - 09.2021
  • - Processed a variety of specialty medical claims, ensuring coding accuracy and compliance
  • - Investigated and reported suspicious claims to mitigate risk and fraud
  • - Provided peer mentorship on accurate claims submission and provider communication

Enrollment Specialist

Aetna
05.2015 - 02.2020
  • - Led team coordination and delegated tasks to maximize performance
  • - Trained new hires on enrollment systems, eligibility guidelines, and HIPAA compliance
  • - Developed internal resources to improve data accuracy and reduce processing errors

Education

Associate of Arts - Human Resources Management

Maricopa Community Colleges
Tempe, AZ
08-2026

Certificate of Technical Studies - Human Resources Management

Cornell University
12.2024

Skills

  • - Claims Adjudication (Medical & Pharmacy)
  • - Claims Analysis & Denial Management
  • - QA Auditing & Process Improvement
  • - Employee Onboarding & Peer Training
  • - Prior Authorization & Insurance Verification
  • - ICD-10 / CPT Coding Knowledge
  • - MS Excel, Word, Outlook, CRM Tools
  • - HIPAA Compliance Remote Work Efficiency
  • - Leadership & Team Delegation
  • - Customer Experience & Conflict Resolution

HIGHLIGHTS & ACCOMPLISHMENTS

  • - Reduced claim denial rate by 22% through proactive follow-ups and training documentation
  • - Recognized by leadership for cross-training peers in claims adjudication best practices
  • - Assisted with QA reviews and internal audits to identify compliance gaps and improve accuracy
  • - Spearheaded mini-training sessions that enhanced system navigation and processing time for new hires

Timeline

Senior Enrollment / Medical Billing Specialist

Cigna
07.2024 - Current

Pharmacy Prior Authorization Specialist

Cigna
09.2023 - 07.2024

Insurance Verification Specialist

GEICO
09.2022 - 09.2023

Medical Claims Representative

Kaiser Permanente
02.2020 - 09.2021

Enrollment Specialist

Aetna
05.2015 - 02.2020

Associate of Arts - Human Resources Management

Maricopa Community Colleges

Certificate of Technical Studies - Human Resources Management

Cornell University