Wale Yaya

Professional Experience

Health and Human Service Commission | TX

Texas Works |  Present 

• Responsible for evaluating applicants and recipients of nutrition and medical programs for case analysis and eligibility determination. 

• Support in the analysis, evaluation, and business documentation of processes and activities to ensure data security, privacy, and process improvement. 

• Collaborate with teams to process work in accordance with state and federal regulations and established procedures.

Driscoll Children’s Hospital | Corpus Christi, TX

Senior QA Claims Analyst | September 2020

• Responsible for conducting complex and technical research studies to investigate, resolve, and recover health plan claims with ability to conduct claim analysis, audits, corrections and resolve claim disputes to ensure accurate and timely reimbursement. 

• Collaborated with claims team and business partners to resolve escalations and complaints; developed staff training and procedural solutions for quality improvements and remediation

• Brainstorm ideas, provide feedback, and coaching recommendations to staff members while attaining a quality average of 98% and receiving a 99.6% for financial claim resolutions and production performance goals during the 2023 first quarter.

• Demonstrated ethical practices by adhering to health plan policies and procedures, maintaining strict compliance with data privacy and confidentiality standards. Brainstorm ideas, provide feedback, and coaching recommendations to staff members while attaining a quality average of 98% and receiving a 115% in production performance goals

• Coordination of benefits for private health insurers and medical providers to determine payer of last resort.

Results Companies | Corpus Christi, TX 

Training Coordinator | January 2018  

• Delivered comprehensive training on health insurance policies and procedures, overseeing staff development and preparing new hires for subsequent training phases.

• Successfully trained and mentored over 150 new employees, equipping them with the knowledge and tools necessary to exceed quality standards.

• Managed virtual and in-person training for new hires and incorporated adult learning principles adaptable for various learning styles, handling team building activities and providing support and mentorship to meet internal benchmarks

• Maintained lowest attrition/turnover rate within the organization and developed resolute employees with strong management skills, teaching multiple systems to meet company goals and objectives 

Core Competencies

Team Management and Leadership, Written and Verbal Communication, Interpersonal Skills, Curriculum training and Instruction, Staff Development, Coaching, Data Management and Interpretation, Confidentiality and Data privacy, Proficient in Software Tools & Systems, and Process Improvement and optimization.

Software & Tools

• Canva: Design and create visuals, presentations, and marketing materials.

• Canvas: Develop and manage online learning environments and content.

• Adobe Suite: Proficient in Adobe Photoshop, captivate for graphic design and multimedia content.

• Google Workspace: Advanced proficiency in Google Docs, Sheets, Slides, and Drive for collaboration and document management.

• SharePoint: Skilled in case management and utilizing relevant policies and procedures.

"Passionate Professional | Driving Excellence and Innovation | Committed to Elevating Success and build relationships | Let's Connect and Shape the Future Together!"