Adrianna Lauramore
Macclenny,United States
Summary
Results-driven professional with extensive experience at Florida Blue, specializing in claim resolution and data analysis. Recognized for strong problem-solving and decision-making skills, complemented by Microsoft Office certification. Proven track record of enhancing team productivity and ensuring timely claims processing while consistently exceeding quality standards.
Overview
8
8
years of professional experience
Work History
BlueCard Host Service Advocate III Claims
Florida Blue
Jacksonville, FL
07.2023 - Current
- Collaborated with other departments to obtain additional information needed for claim resolution.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Analyzed data in order to make appropriate decisions on claim resolution.
- Conducted periodic reviews of pending files to ensure timely resolution of claims matters.
- Responded promptly to inquiries from internal departments regarding claim resolution.
- Worked effectively in team environments to make the workplace more productive.
- Managed data entry into various databases as needed.
FEP Service Advocate III - Institutional
Florida Blue
Jacksonville, FL
01.2022 - 07.2023
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Coordinated benefits while applying applicable deductibles, co-insurance and out-of-pocket costs.
- Input transport claim information and payments into company database.
- Verified claim data correctness in preparation for processing.
- Processed claims according to established quality and production standards, and made corrections and adjustments to solve problems.
- Processed claims for payment or forwarded to appropriate personnel for further investigation.
- Checked documentation for appropriate coding, catching errors, and making revisions.
- Reviewed claims to resolve deferral edits, and hold codes.
FEP Service Advocate III - Professional
Florida Blue
Jacksonville, FL
06.2019 - 01.2022
- Input professional and institutional claim information and payments into company database using quick entry.
- Paid and processed claims within designated authority level.
- Completed required investigations on referred files within established timeframes.
- Entered claim transactions, payments, reserves and other documentation.
- Processed claims using Diamond, Quest, FEP Direct, Imaginator, Provider Connect, EIP, Care Connect, and APT.
- Followed the cue cards provided to process held claims precisely.
Host Claim Entry - PEB Intern
Florida Blue
Baker County, FL
06.2017 - 06.2019
- Collected and organized information for entry, prioritizing entries to increase efficiency.
- Followed data program techniques and procedures to maintain data entry requirements.
- Exceeded quality goals to support team productivity.
- Keyed institutional and professional claims by long entry from imaginator, EIP, and claims repository.
- Processed Blue Card Host TKs and misroute claims.
Education
High School Diploma -
Baker County Senior High School
Glen Saint Mary, FL05.2019
Some College (No Degree) -
Florida Gateway College
Lake City, FLSkills
- Verbal and Written Communication
- Maintaining Updated Records
- Decision-Making Skills
- Group Discussions
- Problem-Solving
- Flexible Schedule
- Honest and Ethical
- Critical Thinking
- Certification in Microsoft Office, Excel, and powerpoint
Timeline
BlueCard Host Service Advocate III Claims
Florida Blue
07.2023 - Current
FEP Service Advocate III - Institutional
Florida Blue
01.2022 - 07.2023
FEP Service Advocate III - Professional
Florida Blue
06.2019 - 01.2022
Host Claim Entry - PEB Intern
Florida Blue
06.2017 - 06.2019
High School Diploma -
Baker County Senior High School
Some College (No Degree) -
Florida Gateway College
Similar Profiles
Christina FredericChristina Frederic
Medicare Appeals & Grievances Coordinator at Florida Blue - Blue Cross Blue Shield Of FloridaMedicare Appeals & Grievances Coordinator at Florida Blue - Blue Cross Blue Shield Of Florida
Abdo TaressaAbdo Taressa
Customer Service Representative at Florida Blue - Blue Cross Blue Shield Of FloridaCustomer Service Representative at Florida Blue - Blue Cross Blue Shield Of Florida
Kristen BrackmannKristen Brackmann
Customer Service Advocate at Blue Cross Blue Shield of Florida, Florida BlueCustomer Service Advocate at Blue Cross Blue Shield of Florida, Florida Blue
Heath WesenbergHeath Wesenberg
Business Support Analyst II at Florida Blue - Blue Cross Blue Shield Of FloridaBusiness Support Analyst II at Florida Blue - Blue Cross Blue Shield Of Florida
LILIAN SANGLILIAN SANG
CMA at Centurion GroupCMA at Centurion Group