Daniya Holmes
Phoenix
Summary
Results driven Benefits Specialist with 6+ years of experience in benefits administration, client advisory, and healthcare operations. Expert in managing high-volume caseloads, resolving complex benefits and claims issues, and guiding clients through enrollment and coverage decisions. Strong background in cross-functional collaboration with carriers, HR teams, and internal stakeholders to deliver efficient, compliant solutions. Known for driving process improvements, supporting Open Enrollment, and elevating the client experience in fast paced environments.
Overview
7
7
years of professional experience
2022
2022
years of post-secondary education
Work History
Benefit Operation Specialist
ADP Total Source
Tempe
2025.04 - Current
- Serve as the primary point of contact for benefits-related inquiries, providing guidance on enrollment, eligibility, and coverage decisions
- Manage a high-volume caseload (50+ cases daily) while maintaining SLA compliance, accuracy, and client satisfaction
- Resolve complex benefits discrepancies by collaborating with carriers, HR teams, and internal stakeholders
- Support Open Enrollment and renewal cycles, ensuring timely processing and a seamless client experience
- Act as a subject matter expert (SME), assisting with onboarding, training, and real-time support for team members
- Identify process gaps and contribute to workflow improvements and operational efficiency initiatives
Benefits & Prior Authorization Specialist
PhilRx
Scottsdale
2023.07 - 2025.04
- Acted as a liaison between providers, pharmacies, and insurance carriers to facilitate coverage approvals and resolve benefit-related issues
- Verified eligibility, benefits, and coverage requirements through payer portals and direct carrier outreach
- Managed end-to-end authorization and claims workflows, including submission, tracking, and resolution of approvals and denials
- Investigated claim discrepancies and collaborated with carriers to ensure accurate claim outcomes
- Guided providers and patients through coverage requirements, appeals processes, and documentation needs
- Maintained compliant and detailed documentation for all case activity and communications
- Managed a high-volume caseload (40–60+ cases daily) while meeting turnaround and accuracy standards
- Identified trends in denials and delays, contributing to process improvements and workflow efficiency
- Collaborated cross-functionally to streamline operations and reduce processing delays
- Supported onboarding and training of new hires to ensure consistency in workflows
Customer Care Representative (Benefits & Claims Sp
Elevance Health (Anthem)
Phoenix
2022.10 - 2023.07
- Served as a primary point of contact for members regarding benefits, claims, eligibility, and coverage questions
- Interpreted plan details and provided clear guidance to support informed healthcare decisions
- Researched and resolved complex claims and coverage issues by coordinating with internal teams and providers
- Educated members on benefit usage, coverage limitations, and next steps for resolution
- Managed high-volume inbound and outbound communications while maintaining service quality and compliance
- Documented all interactions in CRM systems to ensure accurate tracking and regulatory adherence
- Escalated and followed through on complex cases, maintaining ownership until resolution
- Built strong member relationships through empathetic, solution-focused support
- Consistently met performance metrics related to accuracy, efficiency, and customer satisfaction
Certified Medical Assistant
Community Health Center
New London
2019.08 - 2022.10
- Coordinated patient intake, scheduling, and clinical documentation in a fast-paced healthcare setting
- Served as a communication liaison between patients and providers to ensure continuity of care
- Verified insurance information and supported administrative aspects of patient care workflows
- Managed high-volume patient interactions while maintaining professionalism and attention to detail
- Supported office efficiency by assisting with workflow organization and patient coordination
Education
Bachelor of Science -
Colorado Christian University
Denver, CO 2022.05 - 2025.12
Griswold High School
Griswold, CTSkills
Benefits & HR Expertise
- Benefits Administration (Medical, Dental, Vision, 401k, COBRA, FSA, Section 125)
- Eligibility, Enrollment & Life Event Processing
- Open Enrollment & Benefits Renewals
- Benefits Consultation & Client Guidance
- Claims Review, Discrepancy Resolution & Appeals Support
Client & Operations
- Client Relationship Management
- High-Volume Case Management (50 daily)
- Complex Issue Resolution & Escalation Handling
- Cross-Functional Collaboration (HR, Carriers, Internal Teams)
- Customer Experience & Retention Focus
Systems & Tools
- HRIS & Benefits Platforms (ADP Workforce Now, carrier portals)
- CRM & Case Management Systems
- Data Analysis & Reporting (Excel, tracking metrics, audits)
- AI-Assisted Workflow Optimization & Digital Tools
Compliance & Process Improvement
- Regulatory Compliance (ERISA, HIPAA, Section 125)
- Process Improvement & Workflow Optimization
- Documentation Accuracy & Audit Readiness
Accomplishments
- Recognized as a trusted resource for resolving complex benefits and claims issues in high-volume environments
- Consistently managed 50+ daily cases while maintaining strong accuracy, compliance, and service standards
- Contributed to improved workflow efficiency by identifying process gaps and supporting operational improvements
- Supported onboarding and training of new hires, improving team consistency and performance
- Successfully resolved complex coverage and claims discrepancies through cross-functional collaboration with carriers and internal teams
- Delivered high quality client and member support, consistently meeting performance expectations for accuracy and efficiency
Timeline
Benefit Operation Specialist
ADP Total Source
2025.04 - Current
Benefits & Prior Authorization Specialist
PhilRx
2023.07 - 2025.04
Customer Care Representative (Benefits & Claims Sp
Elevance Health (Anthem)
2022.10 - 2023.07
Bachelor of Science -
Colorado Christian University
2022.05 - 2025.12
Certified Medical Assistant
Community Health Center
2019.08 - 2022.10
Griswold High School