Adesko Bankston
North Las Vegas
Summary
Claims Operations and Escalation Coordinator with 6+ years of experience supporting large healthcare payer environments. Specialized in intake, triage, assignment, and tracking of escalated and unresolved claims, including executive and government complaints. Proven ability to manage high-volume email queues, coordinate investigations across analyst teams, produce operational and compliance reporting, and support daily workforce planning through huddles, PTO tracking, and workload distribution. Strong background in provider relations, claims operations, and cross-functional collaboration within regulated healthcare settings.
Overview
11
11
years of professional experience
Work History
Business Analyst Coordinator (Claims Escalation & Complaints Operations)
Optum – UnitedHealth Group
08.2021 - Current
- Serve as primary coordinator for a shared email intake mailbox receiving escalated claims inquiries from hospitals, medical providers, internal staff, and executive leadership.
- Triage, prioritize, and assign unresolved and escalated claims investigations to business analysts based on workload, expertise, urgency, and regulatory timelines.
- Track and manage executive, regulatory, and government complaints, ensuring accurate documentation, timely responses, and audit-ready reporting.
- Produce and maintain operational spreadsheets tracking task volume, task type, analyst assignments, completion status, and resolution trends.
- Prepare and distribute daily huddle agendas highlighting analyst workloads, task status, productivity metrics, and scheduled PTO to support workforce planning.
- Monitor analyst capacity and rebalance assignments to ensure service-level expectations and escalation deadlines are consistently met.
- Develop ad hoc operational and leadership reports upon request, supporting decision-making and process improvement initiatives.
- Act as liaison between claims operations, provider partners, analysts, and leadership to facilitate timely issue resolution and clear communication.
- Identify recurring claim issues and workflow gaps, contributing insights to improve escalation handling, complaint resolution, and operational efficiency.
Non-Clinical Prior Authorization Coordinator
Optum – UnitedHealth Group
11.2018 - 08.2021
- Reviewed non-clinical authorization requests to determine appropriate services in accordance with payer policy and regulatory requirements.
- Responded to provider and internal inquiries regarding authorization status, claim issues, and documentation needs.
- Facilitated dispute resolution between providers, hospitals, and managed care partners.
- Monitored utilization trends and supported reporting for quality and cost-containment initiatives.
Premier Support Solutions Technical Lead
Asurion
12.2014 - 11.2018
- Collaborated with other team members to troubleshoot complex issues and develop solutions.
- Analyzed customer requirements to determine appropriate technological solutions.
- Coordinated with vendors for resolution of any third-party product related issues.
- Troubleshot and resolved problems with programs and systems.
- Connected with clients to identify needs and provide helpful solutions.
- Guided staff members through technical challenges and identified areas needing improvement.
- Troubleshot and updated client software and applications.
- Guided personnel on overall project direction and alignment with prescribed business goals.
- Resolved customer issues by establishing workarounds and solutions to debug and create defect fixes.
- Identified opportunities for process improvements to decrease in support calls.
Education
High School Diploma -
Jones Commercial Prep
Chicago, ILSkills
- Claims Escalation & Issue Resolution
- Appeals, Grievances & Complaint Tracking
- Provider & Hospital Relations
- Executive & Regulatory Complaint Reporting
- Workflow Intake, Triage & Assignment
- Operational & Productivity Reporting (Excel)
- Daily Huddles & Workforce Coordination
- Cross-Functional Stakeholder Support
- Process Improvement & Documentation
Timeline
Business Analyst Coordinator (Claims Escalation & Complaints Operations)
Optum – UnitedHealth Group
08.2021 - Current
Non-Clinical Prior Authorization Coordinator
Optum – UnitedHealth Group
11.2018 - 08.2021
Premier Support Solutions Technical Lead
Asurion
12.2014 - 11.2018
High School Diploma -
Jones Commercial Prep