Summary
Overview
Work History
Education
Skills
Timeline
Generic

Tiffany P. Holmes

Mims

Summary

Detail-oriented and proactive Member Support Specialist with over three years of experience in process improvement, cross-functional support, and documentation management within the commercial, group, and Medicare health insurance sectors. Successfully managed scheduling and calendars for five teams with 98% accuracy while maintaining CRM records and documentation for over 50 accounts. Proven ability to streamline workflows, achieving a 20% reduction in turnaround time. A critical thinker and team leader with strong analytical skills, dedicated to optimizing client interactions and enhancing operational efficiency through exceptional written and verbal communication.

Overview

14
14
years of professional experience

Work History

Member Support Specialist Tier II

Devoted Health
10.2023 - Current
  • Client Relationship optimization by providing prompt, solution-driven support to customers and providers on claims, authorizations, enrollment, and health benefits.
  • Manage client escalations and retention using creative problem-solving and empathy to improve member satisfaction. Strategic crisis management.
  • Implement technology solutions and system integrations using (Orinoco, Salesforce, Slack, CRM tools) to log and track cases efficiently.
  • Partner with internal departments to coordinate cross-functional issue resolution.
  • Leading standardization in initiatives training and mentoring team members.

Senior Grievance Coordinator

Aetna/CVS Health
06.2023 - 10.2023
  • Led case investigations, coordinated multi-department responses, and ensured regulatory-compliant grievance resolutions.
  • Delivered professional written communication to customers regarding case outcomes.
  • Negotiated with vendors and providers to reach fair solutions.

Claims Examiner II-Payment integrity Team

Health First Health Plans
04.2019 - 06.2023
  • Reviewed and adjudicated complex healthcare claims ensuring compliance with CMS, state regulations, and plan documents.
  • Identified patterns in billing errors, system issues, and overpayment recovery opportunities, contributing to significant cost savings.
  • Created process and optimized workflow improvements for Medicare Part D and Part C reports, drove a 25% reduction in churn saving the company approximately $198,000 annually.
  • Performed case management related to provider disputes and coordination of benefits (COB), ensuring timely and accurate resolution of coverage issues.
  • Developed and maintained Medicare compliance reports to support audit readiness and data transparency.
  • Architected collaborative problem-solving with internal departments and provider offices to reduce claim rework and payment delays.

Customer Service Specialist

Health First Health Plans
07.2015 - 07.2019
  • Knowledge and effective communications skills to investigate and resolve customer and provider via phone or email inquiries about health benefits, claims, authorizations, prescriptions, enrollment and related questions.
  • Creative problem solving and alternative positioning techniques to understand each customers underlying concern to reduce negative outcomes.
  • Health insurance knowledge to educate customers and providers on medical pharmacy, vision, and dental benefits, provider reimbursement and provider network.
  • Interact with key contacts in other Health First Health Plans to assist in resolving complex customer issues, facilitating communication with customers regarding outcome.
  • Examine Claims and Explanation of benefits with providers and Clinicians

911 Dispatcher

Cocoa Police Department
04.2014 - 08.2014
  • Answered and prioritized 911 emergency and non-emergency calls with professionalism and accuracy.
  • Dispatched police, fire, and EMS units using CAD, 800 MHz radio systems, and MDTs.
  • Maintained detailed records, call logs, and confidential reports.
  • Monitored transmissions and relayed real-time information to first responders.
  • Operated multiple communication systems including CAD, RMS, and teletype networks.
  • Demonstrated calm decision-making and multitasking skills in high-pressure environments.

Intake Specialist

OneCall Care Medical
08.2011 - 04.2014
  • Responsible for overseeing patient insurance verifications, which includes high volume incoming calls and assigning new patient referral to appropriate department.
  • Comply with all applicable policies and procedures.
  • Confidentiality of all data, including injured worker’s demographic, employee information and operations.
  • Responsible for intake, investigation and resolution of complaints and grievance scenarios for commercial and Medicare products, which may contain multiple issues and may require coordination of responses from multiple business partners.

Education

Associate of Arts Degree -

Eastern Florida State College
Cocoa, FL
05.2026

Skills

  • Proficient in medical terminology
  • Proficient in ICD-9 and ICD-10 coding
  • Client relationship management
  • Proficient in HCPCS coding
  • Organizational time strategies
  • Insurance benefit administration
  • Analytical thinker
  • Collaborative team player
  • Problem-solving expertise
  • Proficient in Microsoft Excel, Outlook, and Word
  • Detail-oriented approach
  • Data analysis and reporting
  • Proficient in Salesforce CRM

Timeline

Member Support Specialist Tier II

Devoted Health
10.2023 - Current

Senior Grievance Coordinator

Aetna/CVS Health
06.2023 - 10.2023

Claims Examiner II-Payment integrity Team

Health First Health Plans
04.2019 - 06.2023

Customer Service Specialist

Health First Health Plans
07.2015 - 07.2019

911 Dispatcher

Cocoa Police Department
04.2014 - 08.2014

Intake Specialist

OneCall Care Medical
08.2011 - 04.2014

Associate of Arts Degree -

Eastern Florida State College

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