Operations & Claims Support Specialist

ERIC WILLIAMS

Atlanta, GA, ***** 336-***-**** *******@***.***

Professional Summary

Proven history of success in optimizing administrative assistance in a genre of environments. Focusing on boosting utilization / department operational efficiency. Well-versed in enforcing strict controls to identify and resolve concerns quickly.

Summary of Qualifications

Known history of working with clients and patient HIPAA regulations while using various programs.

Utilized teamwork with knowledge obtained to ensure a successful outcome within the workplace.

Skills

AS400

Credentialing

Customer Service

Scorecard/Pace

Claims adjudication

FEP Direct / On-base

ICD-9 / ICD-10 / CPT Coding

Lotus Notes

Microsoft Office Suite

Multiline Phone System / PBX

RightFax

Salesforce

Citrix Workspace

9k+ keystrokes

Work History

Optum, Inc - Atlanta, GA

Recovery Resolution Clerk 04/2022-01/2026

Submitted required financial, medical and personal information forms to support client appreciation.

Reviewed outgoing client material for submittal/Scan medical/Medicaid information into PACE database.

Added third party information include work activity, medical conditions, and salary information.

Adjudicated claims before timely filing for approval or denial decision making.

Wipro Limited

Production Data Specialist – Atlanta, GA 08/2021 to 04/2022

Resolved pending healthcare claims and approval requests using various computer systems.

Reviewed inquiries regarding claim adjudication, including paying/denial to meet required metrics.

Applied knowledge of coding and claim processing in a timely manner.

Paralegal (Contract) 01/2020 to 04/2020

Integreon (Cyber Review Team) – Durham, NC

Operated in a contractual role capturing personal identifiable data utilizing various platforms to analyze information.

Analyzed E-discovery software implementation using sensitive information for reporting purposes.

Activated data extractions while processing information related to consumer protection entities.

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