Open to opportunities

Tavonn Cummings

@tavonncummings

Appeals Specialist at Acentra Health resolving medical appeals and grievances with a 24–48 hour turnaround.

At Acentra Health, I resolve medical appeals, grievances, and program policy inquiries from members and providers, meeting a 24–48 hour turnaround standard. I research eligibility, benefits, claims, and service authorization issues, and keep case documentation audit-ready.

At Zenith American Solutions, I administered employer-sponsored healthcare benefits, including eligibility verification, enrollment, and account maintenance. I also processed medical payments and orders and supported members with enrollment and benefit documents.

At VXI Global, I handled escalated billing, account recovery, retention, and service concerns. I advanced quickly, led a team of representatives, and trained and mentored new hires on service processes and systems.

Experience

Work history, roles, and key accomplishments

Current

Appeals Specialist

Current

Acentra Health

Apr 2026 - Present (6 months)

Handle 50–70 calls daily, resolving medical appeals, grievances, and program policy inquiries from members and providers by phone, email, and chat, consistently meeting a 24–48 hour turnaround standard. Research eligibility, benefits, claims, and service authorization issues, process medical payments and orders, and document all contacts in CRM and case management systems.

Grievance Resolution Claims Research Eligibility Verification Benefits Administration Service Authorization Medical Payment Processing CRM Case Management HIPAA compliance Audit Readiness Escalation Management Remote Collaboration

Customer Service Advocate – Benefits Administration

Zenith American Solutions

Nov 2025 - Apr 2026 (5 months)

Handled 50–70 inbound and outbound member calls daily while maintaining HIPAA compliance and service-level standards. Administered employer-sponsored healthcare benefits, processed medical payments and orders, and maintained detailed case notes.

Benefits Administration Eligibility Verification Enrollment HIPAA compliance Call Handling Case Management Appointment Scheduling Documentation

Customer Service Representative

VXI Global

Feb 2023 - Oct 2025 (2 years 8 months)

Handled 100–150 inbound and outbound calls daily, including escalated billing, account recovery, retention, and service concerns. Reviewed account records, verified customer identity, and processed service requests, while consistently meeting quality and productivity targets.

Call Handling Escalation Management Account Recovery Billing Customer Service Quality Assurance Team Leadership Training Mentorship

Member Service Representative – Financial Services (USAA Program)

Teleperformance

Jan 2020 - Jan 2023 (3 years)

Serviced USAA member bank accounts, loans, and claims in a high-volume, highly regulated financial services environment. Handled 100–150 inbound and outbound calls daily, resolving account, loan, and claims inquiries accurately on first contact.

Financial Services Account Servicing Loan Servicing Claims Handling Call Handling First Contact Resolutions Performance Metrics