Tolia Shaw
Columbus,OH
Summary
Maintain a job within the company where I can grow and utilize my excellent Training and Data Entry skills.
Overview
11
11
years of professional experience
Work History
Provider Hold Team
Optum/United Healthcare
05.2017 - Current
- Provider Data Consultant
- Various duties related to the provider network reporting & data analytics: database maintenance, reporting and extracting data for various reports and analyses, initiating database improvement
- Developed and maintained standards for database integrity and quality assurance; coordinated corrective activities to clean database and retain users; managed communication with other departments regarding database improvements.
- Provides subject matter expertise on various claims platforms (i.e. NDB, UNET, ppoONE, COSMOS, CSP FACETS, PULSE, NICE) related to provider claim holds
- Delivered presentations to stakeholders about product updates. on product updates when necessary
- Ensures projects are completed on time and are in scope
- Establishing, communicating and evaluating business requirements & timelines associated with special projects, integrations, migrations, new product development that impact claim hold applications
- Improved process flows and increased automation through system and tool enhancements related to provider claim holds.
- Collaborating with technical resources to implement system solutions inclusive of testing enhancements when required
- Review and approval of system / tool design documents & business requirement documents
- Assisted in developing strategic business solutions through research, audits, and analysis of data and business processes.
- Serves as a key resource on complex and/or critical issues regarding provider claim hold
- Reviews work performed by others and provides recommendations for improvement
- Assist with forecasting of resource requirements based on time studies and/or task difficulty
- Motivates and inspires other team members
- Outlined main responsibilities for the role.:
Provider Data Specialist
United Healthcare
07.2015 - 05.2017
- Calling provider offices following script to verify demographic information that is held on the website. Making sure information is accurate and correct so that members can search for providers and get correct information from website. Following quality standards and consistently meeting quality metrics.
- Selected for a small group focused on My Practice Profile. Worked in PHYCON and reached out to Dr offices via fax to update demographic information.
- Led a Training class for agents learning the My Practice Profile process.
- Primary Responsibilities:
Education
Diploma - General Studies
Whetstone High School
ColumbusSkills
- Cross-functional collaboration
- Cooperation
- Attention to detail
- Multitasking
- Multitasking Abilities
- Database management
- Teamwork
- Project scheduling
Accomplishments
- Achieved database enhancement by completing testing with accuracy and efficiency.
Timeline
Provider Hold Team
Optum/United Healthcare
05.2017 - Current
Provider Data Specialist
United Healthcare
07.2015 - 05.2017
Diploma - General Studies
Whetstone High School
Section name
-Past experience available upon request-