Kimberly Williams
Villa Rica
Summary
Seeking a leadership role in healthcare IT, benefit administration, or compliance, where extensive industry expertise and technical proficiency can contribute to operational success.
Highly skilled healthcare operations and IT professional with over 20 years of experience in healthcare administration, benefit configuration, claims resolution, and customer advocacy. Proven expertise in system configuration, process optimization, and high-level issue resolution across multiple healthcare platforms. Adept at analyzing complex healthcare systems, enhancing workflows, and mentoring teams to improve efficiency and service quality.
Overview
23
23
years of professional experience
Work History
TOPS Configuration Analyst
United Healthcare
04.2022 - Current
- Configure coding and benefit structures based on system capabilities and employer-specific healthcare plans
- Manage benefit plan loading and data entry using multiple databases to ensure system accuracy and compliance
- Provide technical and operational support, addressing inquiries, troubleshooting issues, and resolving complex benefit discrepancies
- Conduct data analysis and case investigation to identify inefficiencies and recommend system improvements
Premier FedEx Super Advocate
United Healthcare
09.2020 - 04.2022
- Handled complex, high-priority cases, resolving escalated and repeat member issues in real-time
- Provided technical and procedural guidance to agents, serving as a Subject Matter Expert (SME) and coaching team members
- Acted as a liaison between members and providers, assisting with appointment scheduling, billing concerns, and coverage determinations
- Facilitated claim reprocessing and issue resolution for held cases, ensuring compliance with company protocols and healthcare policies
Elite Advocate
United Healthcare
09.2019 - 09.2020
- Managed 30-45 inbound calls daily, assisting large group members with benefits, eligibility, and claims inquiries
- Tier 2 escalation handler, resolving complex claims, benefits discrepancies, and reprocessing requests
- Assisted in training and mentoring new hires, enhancing onboarding efficiency and team performance
Service Account Manager Associate
United Healthcare
09.2007 - 09.2019
- Served as a liaison for high-profile accounts, handling prior authorizations, eligibility verification, and billing concerns
- Led first-level escalation resolution for claims processing and customer service issues, collaborating across departments to ensure accuracy
- Managed highly sensitive healthcare projects, maintaining strict adherence to HIPAA guidelines and confidentiality standards
Member Services Representative
Sierra Health & Life
12.2005 - 09.2007
- Managed 60-65 inbound calls daily, ensuring accurate benefit information, provider satisfaction, and claims resolution
- Maintained detailed documentation and compliance records, ensuring adherence to company workflows and regulatory updates
Medical Records Clerk
SMA
04.2002 - 12.2004
- Oversaw patient record processing, retrieval, and organization, ensuring seamless medical documentation access for providers
- Assisted in data collection, registration, and compliance verification, improving record accuracy and patient data security
Education
High School Diploma -
Cheyenne High School
Las Vegas, NV06-2000
Skills
- Healthcare IT & Systems Management – Extensive experience in system configuration, benefit plan loading, case analysis, and claims resolution using industry-leading healthcare databases
- Process Optimization & Data Analysis – Strong analytical and problem-solving skills to streamline operations, improve service delivery, and reduce system errors
- Customer Advocacy & Complex Issue Resolution – Skilled in handling highly escalated cases, resolving provider and member issues, and acting as a liaison between healthcare organizations and patients
- Leadership & Training – Experience as a Subject Matter Expert (SME) and On-the-Job Trainer (OJT), coaching teams, assisting in skill development, and ensuring best practices
- Regulatory Compliance & Risk Management – Strong knowledge of HIPAA, healthcare policy regulations, and insurance compliance standards, ensuring adherence to legal and industry requirements
- Technical Proficiency & Administrative Expertise – Proficient in Microsoft Office Suite, high-speed data entry (80-85 WPM), documentation management, and cross-functional collaboration
Timeline
TOPS Configuration Analyst
United Healthcare
04.2022 - Current
Premier FedEx Super Advocate
United Healthcare
09.2020 - 04.2022
Elite Advocate
United Healthcare
09.2019 - 09.2020
Service Account Manager Associate
United Healthcare
09.2007 - 09.2019
Member Services Representative
Sierra Health & Life
12.2005 - 09.2007
Medical Records Clerk
SMA
04.2002 - 12.2004
High School Diploma -
Cheyenne High School
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