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Dominique Myers

@dominiquemyers

Senior fraud and healthcare customer service professional with 15+ years delivering compliant, empathetic support and accurate case outcomes.

United States
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What I'm looking for

I’m looking for a role where I can investigate fraud and resolve complex member/provider issues—leveraging HIPAA compliance, strong documentation, and performance-driven workflows to deliver accurate, empathetic outcomes.

I’m a healthcare and customer service professional with 15+ years of experience in high-volume call centers, Medicaid managed care, insurance support, fraud investigation, and clinical environments. I’m known for delivering empathetic, accurate, and efficient support while consistently meeting performance metrics and compliance standards.

In fraud and claims-focused roles, I investigate fraud and identity theft cases, document findings, and ensure regulatory compliance using tools like LexisNexis and Innovis. I also handle member and provider services such as eligibility and benefits verification, claims processing, prior authorizations, referrals, and escalated issue resolution.

I’ve also built strong clinical grounding as a Registered Medical Assistant, supporting patient care, documenting in EPIC and Cerner EMR systems, and maintaining HIPAA compliance. In leadership experience, I’ve led a team of 27 representatives, strengthening quality and adherence through clear accountability and coaching.

Experience

Work history, roles, and key accomplishments

KI

Customer Service Team Lead

KForce Solutions (IlliniCare Health Insurance)

Oct 2017 - Apr 2018 (6 months)

Provided Medicaid Managed Care and ACA member/provider support through high-volume inbound calls, verifying eligibility, benefits, referrals, and prior authorizations. Led a team of 27 representatives by processing and researching medical claims and coordinating claim resubmissions to support quality and adherence.

CP

Specialty Pharmacy Rep

CVS Health Specialty Pharmacy

Jan 2016 - Apr 2017 (1 year 3 months)

Managed 80–200 inbound calls daily from patients and providers for prescription refills, insurance coverage, and benefit questions. Coordinated with physician offices for prior authorizations and medication updates, maintained accurate documentation in case management systems, and conducted outbound adherence/refill follow-ups.

Education

Degrees, certifications, and relevant coursework

Dominique hasn't added their education

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Tech stack

Software and tools used professionally

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