Summary
Overview
Work History
Education
Skills
Awards
Administrative Skills/ Applications
Timeline
Generic

La Tanza Williams

Chicago

Summary

Detail-oriented Claims Liaison with over 5 years of experience leading cross-functional efforts between departments, provider relations, and internal teams to resolve complex claims issues. Proven ability to identify trends, analyze data, and drive process improvements that enhance claims accuracy and efficiency. Skilled in provider education, system troubleshooting, and fostering collaboration to ensure smooth, compliant claims processing in fast-paced healthcare environments.

Overview

11
11
years of professional experience

Work History

Claim Liaison I

Centene Corporation
08.2021 - Current
  • Liaise with provider relations, claims, and internal teams—including Authorization, Configuration, and PDM—using department-specific language to resolve complex claim and provider setup issues.
  • Investigate and resolve claim discrepancies and disputes in compliance with HFS and CMS guidelines.
  • Analyze and route claims to be appropriate units for recovery, reprocessing, or adjustment.
  • Identify systemic issues and escalate for configuration changes or technical fixes, ensuring long-term resolution.
  • Generate and interpret SQL-based “golden reports” to assess large-scale claim errors and drive corrections.
  • Review denied or overpaid claims to determine recoupment actions and validate authorization statuses.
  • Led process improvement efforts, reducing average claim resolution time by 20%–50%.
  • Trained and mentored new hires on applications such as Amisys and internal workflows, enhancing team accuracy, efficiency, and system proficiency.
  • Communicated regularly with providers and internal teams, including Authorization, to support timely approvals and resolve care-related issues.
  • Managed communications with healthcare providers, responding to inquiries and resolving issues to support member services.

Provider Relations Support

Della Adult Foster Care
07.2019 - 12.2021
  • Facilitated coordination between providers and client support teams, ensuring timely follow-up and smooth care management.
  • Gained hands-on experience with provider workflows, member support, and issue resolution—building a strong foundation in provider relations.
  • Collaborated with providers to update and clarify care plans, ensuring seamless delivery of services in a home-based environment.
  • Assisted in streamlining workflows and sharing best practices, contributing to team efficiency and quality care.
  • Maintained compliance with healthcare standards while managing medication administration and client support.
  • Accurately documented care activities and communications to support continuity and quality assurance.

Farm & Ranch Underwriter I

State Auto Insurance
02.2014 - 04.2019
  • Reviewed and evaluated new insurance submissions to decide whether to approve, modify, or decline coverage based on risk and company profitability.
  • Analyzed documents such as loss history, property condition, and driver records to support sound underwriting decisions—like claim assessment in current role.
  • Worked closely with sales teams and agencies during client visits and events, building strong communication and collaboration skills.
  • Compared similar policy risks and contributed to actuarial reviews, helping improve policy accuracy and risk pricing—experience now applied in claims trend analysis.
  • Trained and supported assistant underwriters and led interdepartmental sessions, laying the foundation for mentoring new recruits in claims operations.
  • Prepared recommendations for policy changes and renewals, ensuring compliance with underwriting standards and internal review processes.
  • Coordinated and scheduled medical appointments using healthcare systems, ensuring accuracy and alignment with client care plans.

Direct Support Team Member

Rescare Community Living
01.2015 - 01.2016
  • Facilitated coordination between providers and client support teams, ensuring timely follow-up and smooth care management.
  • Gained hands-on experience with provider workflows, member support, and issue resolution—building a strong foundation in provider relations.
  • Collaborated with providers to update and clarify care plans, ensuring seamless delivery of services in a home-based environment.
  • Assisted in streamlining workflows and sharing best practices, contributing to team efficiency and quality care.
  • Maintained compliance with healthcare standards while managing medication administration and client support.
  • Accurately documented care activities and communications to support continuity and quality assurance.

Education

Business

Ivy Tech Community College
Indianapolis, Indiana

Skills

  • Claims Analysis and Resolution
  • Data Accuracy
  • Trend Analysis
  • Cross-Functional Collaboration
  • Analytical Problem-Solving
  • Critical Thinking
  • Dependability
  • Professionalism
  • Strong written communication

Awards

MVP Award, Most Trusted Employee, Centene Corporation-2003, Co-led development of department procedural manual, Toast Masters, Girl Scout Leader

Administrative Skills/ Applications

CenPas, ECM Claim Image, TruCare/TruCare Cloud, Amisys, Service Now, WebStrat, MicroStrategy, CenProv, DST, Portico, Golden6, PSI, PaySpan, Dauntless, Microsoft Applications Mainframe, Guide wire, Lexis/Nexis, Wolter Kluwer's, MYSA, E360, Workday, V6 and V7

Timeline

Claim Liaison I

Centene Corporation
08.2021 - Current

Provider Relations Support

Della Adult Foster Care
07.2019 - 12.2021

Direct Support Team Member

Rescare Community Living
01.2015 - 01.2016

Farm & Ranch Underwriter I

State Auto Insurance
02.2014 - 04.2019

Business

Ivy Tech Community College

Similar Profiles

CREATE PROFILE
La Tanza Williams