Octavia Dawkins
Kings Mountain
Summary
Detail-driven Data Analyst with over 7 years of experience in claims investigation, financial data analysis, and regulatory compliance within the healthcare and insurance sectors. Recognized for uncovering fraud trends, reconciling discrepancies, and driving data accuracy that improved operational efficiency and reduced follow-up complaints. Skilled in Excel-based reporting, claims adjudication systems (ACAS), and data-driven process improvement. Adept at transforming complex datasets into actionable insights that strengthen decision-making, enhance compliance, and streamline workflows. Equipped with a track record of analytical excellence, integrity, and precision that helps organizations optimize outcomes and negotiation of claim reimbursements.
Overview
10
10
years of professional experience
Work History
Negotiator Analyst
Aetna
Kings Mountain
12.2025 - Current
- Facilitated negotiations between healthcare providers and Aetna to align interests.
- Analyzed contract terms to ensure compliance with company policies and regulations.
- Collaborated with cross-functional teams to develop strategic negotiation plans.
- Managed conflict resolution during negotiations to maintain positive relationships.
Client Advocate
Aetna
Kings Mountain
01.2020 - 12.2025
- Synthesize complex claims and account data in Excel and ACAS to detect recurring discrepancies, improving reconciliation accuracy and reducing client follow-up complaints by 20%.
- Streamline client inquiry resolution by building data-driven feedback reports that highlight systemic claim errors, supporting training enhancements, and workflow efficiency.
- Evaluate high-volume customer records to pinpoint process bottlenecks using advanced data analysis systems, driving data integrity improvements and accelerating issue turnaround time.
- Visualize client satisfaction metrics using reporting dashboards to monitor service KPIs, enabling leadership to make informed operational decisions.
- Collaborate cross-functionally with compliance and adjudication teams to ensure claims accuracy under HIPAA and Medicare guidelines, reinforcing regulatory alignment.
SIU Analyst
Aetna
01.2019 - 01.2020
- Analyzed 200+ medical claims daily to identify fraudulent billing patterns, applying quantitative techniques in Excel and ACAS that prevented financial losses.
- Correlated paid-versus-billed data to validate claim legitimacy, strengthening audit reliability and ensuring adherence to internal compliance thresholds.
- Tracked fraud indicators and reporting volumes, generating weekly fraud-trend summaries for management that supported data-driven investigations and policy adjustments.
- Integrated cross-departmental findings with medical directors to confirm billing validity, improving investigative precision and claim adjudication speed.
- Standardized data-entry protocols to reduce false positives, improving fraud-detection efficiency and cutting manual review workload by 15%.
Claims Benefit Specialist
Aetna
01.2016 - 01.2019
- Processed and validated Medicare, Medicaid, and international personal claims with a focus on accuracy and compliance, ensuring complete data capture and timely adjudication.
- Reconciled discrepancies between system-generated and manual claim entries in Excel, raising data accuracy rates and lowering rework volume.
- Extracted trend insights from claim rejections to support root-cause analysis, helping management refine error-prevention protocols.
- Coordinated case documentation and reporting across multiple regions, promoting standardized data handling and compliance consistency.
- Enhanced communication workflows by consolidating client feedback data, which improved transparency and overall customer experience metrics.
Education
BS - Accounting
Strayer University
Associate Degree - Accounting
Strayer University
Skills
- Claims Investigation & Adjudication
- Healthcare Fraud
- Risk Analysis
- Financial Data Reconciliation
- Regulatory Compliance
- Data Reporting
- Worked in a fully remote environment
- Managed workload independently across time zones
- Trend Analysis
- Process Improvement
- Quality Assurance
- Client Advocacy
- Issue Resolution
- Audit Support
- Root Cause Analysis
- Error Prevention
- Cross-Functional Collaboration
- Documentation
- Case Management
- Analytical Problem Solving
- Written & Verbal Communication
- Time Management
- ACAS
- MS Excel
- VLOOKUP
- Pivot Tables
- CRM Tools
- Data Visualization Systems
Websites
Personal Information
Title: Data Analyst
Timeline
Negotiator Analyst
Aetna
12.2025 - Current
Client Advocate
Aetna
01.2020 - 12.2025
SIU Analyst
Aetna
01.2019 - 01.2020
Claims Benefit Specialist
Aetna
01.2016 - 01.2019
BS - Accounting
Strayer University
Associate Degree - Accounting
Strayer University