JAYLON MARTIN
Summit
Summary
Healthcare Operations & Provider Support Specialist with 5 years of experience supporting Medicare Advantage programs, resolving complex healthcare escalations, ensuring CMS compliance, and driving operational excellence in highly regulated healthcare environments. Skilled in issue investigation, stakeholder communication, quality assurance, provider support, and cross-functional collaboration. Recognized for delivering timely resolutions, maintaining regulatory compliance, and supporting initiatives that improve healthcare service delivery and member outcomes
Overview
5
5
years of professional experience
Work History
Resolution Specialist
UST Healthproof
06.2024 - Current
- Investigate and resolve complex healthcare escalations, grievances, appeals, and operational concerns while ensuring compliance with CMS regulations and organizational standards.
- Manage assigned Jira cases involving plan discrepancies, benefit concerns, service issues, and high-priority escalations.
- Collaborate with cross-functional stakeholders to identify root causes, support issue resolution, and improve operational effectiveness.
Subject Matter Expert – Medicare Advantage
Everise
11.2022 - 04.2024
- Served as a subject matter expert supporting complex Medicare Advantage and Prescription Drug Plan inquiries, escalations, grievances, and appeals.
- Provided education and guidance regarding CMS regulations, Medicare policies, and compliance requirements.
- Delivered coaching and training sessions that improved quality performance and compliance adherence.
Customer Service Representative – Medicare Resolution
Teleperformance
08.2021 - 09.2022
- Resolved complex Medicare inquiries involving eligibility, enrollment, benefits, prescription drug coverage, billing concerns, and claims-related issues.
- Investigated member concerns and coordinated with internal departments to support timely issue resolution.
Education
High School Diploma - undefined
South Pike High School
Magnolia, MississippiSkills
- Salesforce
- Jira
- CRM Systems
- Microsoft Office Suite
- Telephony Systems
- Documentation Review
- Compliance Monitoring
- Quality Assurance
- Regulatory Documentation
- Case Investigation
Websites
CORE COMPETENCIES
- Healthcare Operations
- Provider Support & Communication
- Medicare Advantage (MA-PD)
- CMS Compliance
- Escalation Resolution
- Stakeholder Engagement
- Relationship Building
- Quality Assurance
- Regulatory Documentation
- Issue Investigation
- Cross-Functional Collaboration
- Process Improvement
- Training & Coaching
- Salesforce
- Jira
- CRM Systems
Timeline
Resolution Specialist
UST Healthproof
06.2024 - Current
Subject Matter Expert – Medicare Advantage
Everise
11.2022 - 04.2024
Customer Service Representative – Medicare Resolution
Teleperformance
08.2021 - 09.2022
High School Diploma - undefined
South Pike High School