Wiletta Beauford
Summary
Proven Claims Management Expert with a robust background at Aetna, CVS Health. Excelled in streamlining claims processes and mentoring teams, enhancing efficiency and provider satisfaction. Skilled in QNXT and SQL, coupled with exceptional interpersonal abilities, consistently maintained top-quality ratings and fostered a collaborative work environment.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Sr. Claims Benefit Specialist
Aetna, CVS Health
06.2021 - Current
- Streamlined interdepartmental communication channels enabling faster resolutions on problematic claims.
- Mentored junior staff members, developing their skills in claim analysis, negotiation, and settlements.
- Championed efforts towards maintaining a positive work environment within the Claims Department by promoting teamwork and collaboration.
- Recognized as a subject matter expert in claims processing, regularly consulted by peers for guidance on challenging cases.
- Enhanced provider satisfaction, addressing escalated concerns promptly and professionally.
- Managed entire project portfolio for New Jersey Medicaid claims.
- Maintained excellent quality ratings throughout the year.
Claims Benefit Specialist
Aetna, CVS Health
06.2015 - 06.2021
- Provided exceptional customer service by addressing client inquiries promptly and professionally.
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Reviewed policy coverage details thoroughly before making determinations on benefits eligibility for each unique claim scenario presented.
- Checked documentation for accuracy and validity on updated systems.
- Maintained up-to-date knowledge on industry regulations and guidelines, ensuring compliance throughout the claims process.
Default Reporting Team Lead
Everhome Mortgage Company
11.2004 - 02.2015
- Trained new team members by relaying information on company procedures and safety requirements.
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Served as a role model for the team by demonstrating commitment to excellence, professionalism, and adherence to company values at all times.
- Coached team members in techniques necessary to complete job tasks.
Education
Bachelor of Science - Family And Consumer Sciences
Florida State University
Tallahassee, FL12.1996
High School Diploma -
William M Raines Sr. High School
Jacksonville, FL06.1992
Skills
QNXT, Quickbase, SQL, Burgess, EncoderPro, IOP
- Claims Management Expertise
- Attention to detail and accuracy
- Superior organizational skills
- Critical Thinking Capabilities
- Exceptional interpersonal skills
Certification
- LMT - Licensed Massage Therapist
Timeline
Sr. Claims Benefit Specialist
Aetna, CVS Health
06.2021 - Current
Claims Benefit Specialist
Aetna, CVS Health
06.2015 - 06.2021
Default Reporting Team Lead
Everhome Mortgage Company
11.2004 - 02.2015
Bachelor of Science - Family And Consumer Sciences
Florida State University
High School Diploma -
William M Raines Sr. High School
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