Operations - Data & Documentation Specialist

CHIDERA AJAH

Dallas, TX

213-***-**** *******@*****.***

SUMMARY

Detail-oriented and highly versatile professional with over a decade of experience spanning healthcare operations, financial services, case management, and customer service. Proven track record in process analysis, claims resolution, and documentation management, with expertise in navigating complex systems like Salesforce, EPIC, and various claims and case databases. Adept at handling sensitive data in compliance with HIPAA, FCRA, and industry regulations. Recognized for cross-functional collaboration, analytical thinking, and delivering high-quality support in remote, fast-paced environments. Demonstrates strong leadership, problem-solving, and customer engagement skills cultivated through roles in healthcare, insurance, and retail.

SKILLS

Technical & Tools: Salesforce, EPIC, Microsoft Office Suite, Google Workspace, Document Management Systems, Claims Processing Systems, CRM & Case Management Tools

Core Competencies: Document Review & Processing, Data Accuracy & Quality Control, HIPAA & Regulatory Compliance, Claims Resolution & Billing Support, Customer Service & Call Resolution, Cross-Functional Collaboration, Workflow Optimization, Audit Preparation & Compliance, Root Cause Analysis, Time Management & Prioritization

EXPERIENCE

Nations Benefit – Remote. August 2024 – Present

Document Specialist/Data Entry Clerk

Reviews and process high volumes of healthcare-related documents to ensure accuracy, completeness, and compliance with organizational and regulatory standards.

Validates member and provider submissions, identifying discrepancies and coordinating resolutions with internal teams.

Maintains secure and organized electronic records using document management systems, ensuring timely retrieval and audit readiness.

Collaborates cross-functionally with departments such as Claims, Eligibility, and Member Services to streamline workflows and support operational efficiency.

Ensures HIPAA compliance by safeguarding sensitive health and personal information during all document handling processes.

Monitors document queues and prioritize tasks to meet productivity goals and service-level agreements (SLAs).

Assists in refining documentation protocols and process guidelines to improve team accuracy and throughput.

Review, validate, and index incoming documents to ensure completeness and compliance with organizational and HIPAA standards.

Perform quality checks to identify and correct errors or inconsistencies in submitted data and documentation.

Maintain organized electronic records for easy retrieval during audits and internal reviews.

McKesson – Remote. December 2023 – August 2024

Process Analyst/Case Worker

Verified client eligibility by reviewing documentation such as proof of income and insurance, supporting accurate case determinations.

Analyzed trends in case data and operational issues, escalating insights to management to improve workflows and client outcomes.

Reviewed and entered inbound documents into databases while adhering to strict accuracy and productivity metrics.

Facilitated patient medication orders and liaised with pharmacies to ensure timely, accurate fulfillment and continuity of care.

Maintained and updated case files and records in Salesforce, ensuring data accuracy and consistency across systems.

Supported compliance and audit readiness by adhering to established documentation and data entry protocols.

Delivered high-quality administrative support by handling additional departmental tasks and ensuring operational continuity.

Conducted root-cause analysis to troubleshoot technical and data-related issues, implementing effective solutions promptly.

Managed full case lifecycle workflows, tracking progress to ensure timely completion of tasks and service-level goals.

Identified errors, inconsistencies, and data gaps through quality checks and resolved them proactively to maintain integrity.

Ensured compliance with HIPAA and internal privacy standards by validating and safeguarding sensitive patient data.

Collaborated cross-functionally with teams including account management to resolve inquiries, share insights, and support client satisfaction.

Documented standard operating procedures and updated internal process manuals to reflect best practices and policy changes.

Monitored caseloads and anticipated future needs based on historical trends and transaction patterns.

Sharp Health – Remote May 2022 – December 2023

Claims Representative

Answered inbound calls from members, providers, and authorized representatives to address inquiries related to benefits eligibility, billing and payments, treatment authorizations, EOBs, and claim statuses.

Processed and reviewed medical claims to ensure accuracy, eligibility, and compliance with payer policies and healthcare regulations.

Investigated and resolved denied, delayed, or incorrectly processed claims through coordination with providers, insurance companies, and internal departments.

Utilized electronic claims systems using EPIC to track claim statuses, submit appeals, and ensure timely reimbursement.

Maintained detailed documentation of claim activity and correspondence, supporting audit readiness and compliance requirements.

Interpreted Explanation of Benefits (EOBs), remittance advice, and authorization documents to reconcile payments and resolve billing discrepancies.

Communicated with patients and healthcare providers to clarify billing issues and provide resolution guidance.

Met or exceeded daily productivity and accuracy standards in a fast-paced, deadline-driven environment.

Stayed current on industry updates, payer guidelines, and coding standards (CPT, ICD-10) to ensure claim integrity and reduce rework.

Researched complex customer concerns across multiple systems and collaborated with internal teams to resolve issues efficiently and accurately.

Resolved a high volume of customer inquiries on the first call by navigating multiple systems, documenting interactions per compliance standards, and collaborating with cross-functional teams to manage escalations—consistently meeting performance targets for resolution time, efficiency, and customer satisfaction.

Toyota Financial Services – Remote January 2021 – May 2022

Document Specialist

Processed and reviewed high volumes of loan and lease documentation for accuracy, completeness, and compliance with regulatory standards.

Verified rebate eligibility and applied incentives to customer accounts in coordination with dealership partners and internal teams.

Coordinated with internal departments to resolve discrepancies and ensure timely document submission and funding.

Maintained digital and physical document repositories, ensuring proper indexing, retrieval, and secure storage of customer records.

Utilized document management systems to track, update, and validate financial documents in support of operational workflows.

Ensured confidentiality and compliance with federal privacy regulations (e.g., GLBA, FCRA) during all document handling processes.

Provided support for audits and quality assurance by preparing and verifying document packets as requested by compliance teams.

Demonstrated attention to detail and adherence to deadlines in a fast-paced, high-volume remote work environment.

Neiman Marcus – San Francisco, CA October 2019 – January 2021

Customer Service Representative

Cultivated long-term client relationships by providing personalized service, earning trust, and driving repeat business through exceptional customer care.

Performed cross-sells and upsells based on clients’ preferences to boost sales and contribute to overall revenue growth.

Maintained and updated client books, proactively following up on sales, special requests, and service inquiries.

Shared in-depth product knowledge and made personalized recommendations to enhance the customer experience and maximize satisfaction.

Placed special merchandise orders for clients and sourced unique products to meet individual customer needs.

Informed customers about current promotions and sales events in a friendly and engaging manner to drive interest and conversion.

Worked collaboratively with team members to deliver high service standards and foster a positive shopping environment.

Demonstrated urgency and attentiveness in serving customers, ensuring all needs were met efficiently and with care.

Performed general store upkeep, including restocking, organizing displays, and maintaining cleanliness throughout and after store hours.

Bloomingdales – San Francisco, CA April 2018 – October 2019

Sales Associate

Built strong, trust-based relationships with repeat customers by delivering personalized service and anticipating their needs, leading to increased sales and customer loyalty.

Performed cross-selling and upselling strategies tailored to client interests, effectively boosting store revenue and enhancing the customer shopping experience.

Advised customers on merchandise selection based on individual needs and preferences, while efficiently processing exchanges and returns.

Proactively informed customers about ongoing promotions and sales in a friendly, engaging manner to drive interest and conversion.

Tracked down and placed special merchandise orders to accommodate unique customer requests, ensuring satisfaction and retention.

Shared in-depth product knowledge to make thoughtful recommendations, always prioritizing customer needs with a sense of urgency and care.

Worked collaboratively with team members to maintain a seamless, high-quality shopping environment and ensure top-tier customer service.

Contributed to store maintenance by organizing shelves, restocking merchandise, and cleaning to uphold a welcoming and professional store appearance.

World Financial Group - Boston, MA January 2014 – April 2018

Marketing and Sales Representative (Life Insurance Agent)

Customized comprehensive insurance programs for individual and business clients, tailoring coverage to meet diverse financial and personal risk needs.

Conducted in-depth interviews with prospective clients to gather financial data, assess insurance requirements, and evaluate existing coverage.

Successfully led a multidisciplinary team of 25 to 40 agents, setting performance targets and ensuring alignment with organizational objectives.

Provided high-level client service by thoroughly explaining policy options, benefits, and procedures, resulting in tailored solutions and long-term relationships.

Ensured fulfillment of all policy requirements, including coordination of medical exams and completion of relevant documentation to maintain compliance.

Trained and mentored new agents on sales strategies, compliance standards, and product knowledge to support team development and performance growth.

Maintained up-to-date knowledge of industry regulations, insurance products, and market trends to provide accurate information and stay competitive.

Built and maintained long-term client relationships through consistent follow-up, financial reviews, and personalized support, resulting in strong client retention and referral business.

Work Incorporated - Boston, MA March 2011-Jan 2014

Program Manager

Managed a 1.3million budget; analyzed and planned the company’s expense and submitted reports to CFO for approval.

Pioneered the introduction of a series of leading-edge forms to ensure accurate and straightforward documentation; achieved 94% accuracy in 5months

Supervised a department of 13 case managers; communicated expertly with the team to help ensure a high functioning team, which led to 87% employee retention ratio and 6 case managers promoted. Interviewed & trained new employees.

Nasky And Goldfinger - Salem, NH August 2007 – March 2011

Executive Assistant

Facilitated team charged with the improvement of inventory record accuracy; team resulted in (improved on-time delivery from 53% to 96%, eliminated annual inventory losses exceeding $400,000, reduced freight costs by 3%, and improved record accuracy by 91%)

Provided high-level administrative support to senior executives, managing calendars, preparing reports, coordinating travel, and handling confidential communications.

Organized and supported departmental meetings, tracked project milestones, and ensured timely completion of strategic initiatives by liaising across departments.

EDUCATION

BSc Business Administration

Salem State University, USA

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