Waleea Anderson
Jacksonville,FL
Summary
Results-driven professional with strong interpersonal skills and a proven track record in problem solving. Demonstrates excellence in customer service while consistently achieving company goals. Recognized as a dedicated team player and peer mentor, focused on driving results and fostering collaboration.
Overview
10
10
years of professional experience
Work History
Overpayment Recovery Unit
Florida Blue/Guidewell
01.2022 - Current
- Researching, resolving, and answering provider inquiries via mail, Availity Tool (electronic) related to overpayment invoices and provider statements in a timely manner.
- Provide adequate research and processing instructions to appropriate business areas for manual PeopleSoft Accounts Receivable system generated refunds to providers.
- Completion of the non-permitted disclosure event spreadsheet for BEIC (Business Ethics Integrity Compliance) reporting.
- Provide feedback and claims instructions to various internal areas when errors have occurred such as claim adjustment errors, cash application errors and financial errors.
- Interact with other internal business partners, insurance adjustors, attorneys, and members
- Provide single point of contact or SME support to select high-profile, high-volume providers to ensure that urgent, escalated issues are handled timely and on first contact.
Pre-Service Medical Review
Florida Blue/Guidewell
01.2020 - 01.2022
- Resolved issues, inquiries to member and providers ensuring understanding of the company’s products and services.
- Served as a primary resource to providers.
- Liaison between hospitals, physicians, health plans, vendors, patients or referral sources.
- Initiated and managed clinical referrals, and authorizations for inpatient, outpatient, advanced imaging, and various specialist.
- Determined contract and benefits eligibility
- Referred cases that required clinical review to appropriate clinical professionals (R.N, M.D)
- Reviewed, attached and forwarded images to the appropriate area.
Service Advocate IV
Florida Blue/Guidewell
01.2016 - 01.2020
- Provided customer service support to members by answering complex benefit questions inquiry resolution; enrolling, billing and collecting payments
- Create and view prior authorizations for providers using JIVA to render services if required.
- Chosen to participate in and trained in Provider Appeals
- Trained and coached new employees to improve their performance and productivity
- Provided technical oversight and subject matter expertise for assigned team
Education
Andrew Jackson Highschool
Jacksonville, FL05.2025
Skills
- Microsoft Office Suite
- Spreadsheet management
- Document creation
- Team collaboration
- Email communication
- Claims processing
- Web browser proficiency
Timeline
Overpayment Recovery Unit
Florida Blue/Guidewell
01.2022 - Current
Pre-Service Medical Review
Florida Blue/Guidewell
01.2020 - 01.2022
Service Advocate IV
Florida Blue/Guidewell
01.2016 - 01.2020
Andrew Jackson Highschool