Tylesia Stephens

• Owned healthcare cases from intake through resolution, ensuring accurate documentation, timely follow-up, and appropriate escalation when required.

• Reviewed and analyzed high-volume medical claims, documentation, and system data to determine coverage eligibility and compliance with Medicare and policy guidelines.

• Performed structured troubleshooting to identify root causes of claim discrepancies, missing documentation, and system issues.

• Communicated clearly with clinicians, providers, and policyholders to explain findings, next steps, and resolution outcomes.

• Documented case activity, findings, and resolutions in CRM systems while maintaining HIPAA compliance and audit-ready records.

• Exercised judgment to determine appropriate resolution paths, including approvals, denials, escalations, or additional investigation.

• Maintained productivity and quality metrics while working independently in a fully remote environment.

• Provided frontline support to healthcare members through high-volume phone interactions while meeting strict performance and quality standards.

• Navigated healthcare systems to research inquiries, resolve issues, and document outcomes accurately in internal systems.

• Collaborated with team members to improve workflows and response times in a remote support environment.

• Ensured HIPAA compliance and data privacy in all customer interactions.

• Coordinated with insurance carriers to review policies, patient benefits, and reimbursement requirements.

• Troubleshot claim and reimbursement issues by reviewing documentation, identifying discrepancies, and determining corrective actions.

• Collaborated with cross-functional teams to resolve complex claim issues and improve turnaround times.

• Optimized data entry and documentation processes to improve speed and accuracy without compromising compliance.

• Provided guidance to customers regarding claims processes, rights, and dispute prevention.