Dejanetta Pettaway
Charlotte
Summary
Experienced service professional with a strong background in the health insurance industry, seeking to transition into the human services and social work field. Dedicated to securing a challenging position that effectively leverages my education and expertise, while also offering ample opportunities for supporting and advocating for special populations.
Overview
18
18
years of professional experience
Work History
Client Relationship Coordinator
Key Benefit Administrators
02.2023 - Current
- Coordinate and track Direct To Employer Implementation and Project Management Office operational tasks.
- Handle Direct To Employer client, broker, vendor and internal operational tasks
- Assist with contractual and administrative implementation and Direct To Employer program enhancements.
- Monitor post implementation activity and indicators.
Claims Administrator
Maestro Health
05.2017 - 11.2022
- Process Medical and Vision Direct Billing and Reimbursement claims within outlined time frames to meet Performance Guarantees
- Managed outside pricing vendor invoices and monthly reporting
- Build effective relationships with external vendors and partners
- Assist with STD payment processing and records management
- Served as the claims liaison between Client Brokers and Employer groups to identify and resolve claims issues
Customer Service Representative
Integra Employer Health
08.2014 - 05.2017
- Administer Medical, Dental, Vision, and Flexible Spending Benefits for Group Health Plans
- Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment
- Referred unresolved customer grievances to designated departments for further investigation
- Served as the main liaison between customers, management, and Brokers
Rapid Resolution Expert
United Health Care
01.2012 - 06.2014
- Provides individuals enrolled in a United Healthcare plan, fast and accurate claim processing and adjustment as well as resolution to escalated claims issues
- Identifying and resolve customer issues real time as well as preventing the issue from reoccurring in the future by resolving the root of the issue
- Maintain detailed and accurate documentation on the issue as well as doing any follow up required to ensure issue resolution
- De-escalating irate callers with empathy and patience and a real-time resolution to their concerns
Shelter Manager
Greensboro Urban Ministry
11.2008 - 05.2014
- Referred families to community agencies, legal resources and educational programs
- Interviewed and evaluated clients, including conducting safety and risk assessments
- Referred clients to social services agencies
- Observed and monitored client behavior, attendance, and adherence to program guidelines
Health Advisor
United Health Care
10.2008 - 01.2012
- Assist members with selecting the best benefit plan options available to them through the enrollment process, including enrollment in specialized care programs
- Accurately documented, researched and resolved customer service issues
- Answered an average of 65 calls per day by addressing customer inquiries, solving problems and providing new plan information
Direct Care Staff/Life Skills Coach
Arc of High Point
04.2007 - 10.2008
- Maintained regular contact with clients, including visiting clients' homes
- Developed and taught lessons on activities of daily living for client's recently transitioned into independent living
- Supervised meal preparation and medication management for individuals residing in an adult group home
- Adhered to all company and legal guidelines for record keeping and maintenance
Education
Master of Science - Human Services
Capella University
Minneapolis, MN06.2016
Graduate Certificate - Contemporary Theory in Couple And Family Systems
Capella University
Minneapolis, MN12.2021
Certification in Contemporary Theory in Addictive Behavior -
Capella University
12.2020
BA - Sociology
University of North Carolina
05.2006
Skills
- Claims Evaluation Skills
- Data Validation
- Clear Communication with Clients
- Detailed Transaction Tracking
- Skilled in Microsoft Office Applications
- Collaborative Problem Solving
- Documentation Expertise
- Collaborative Communication Skills
- Cross-Cultural Understanding
- Excellent Communication
- Effective Listening
- Informed Decision Making
- Client Assessment
- Performance Monitoring
- Interdepartmental Collaboration
- Direct To Employer Network Maintenance
Timeline
Client Relationship Coordinator
Key Benefit Administrators
02.2023 - Current
Claims Administrator
Maestro Health
05.2017 - 11.2022
Customer Service Representative
Integra Employer Health
08.2014 - 05.2017
Rapid Resolution Expert
United Health Care
01.2012 - 06.2014
Shelter Manager
Greensboro Urban Ministry
11.2008 - 05.2014
Health Advisor
United Health Care
10.2008 - 01.2012
Direct Care Staff/Life Skills Coach
Arc of High Point
04.2007 - 10.2008
Graduate Certificate - Contemporary Theory in Couple And Family Systems
Capella University
Certification in Contemporary Theory in Addictive Behavior -
Capella University
BA - Sociology
University of North Carolina
Master of Science - Human Services
Capella University
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