Ashah Whalum
Decatur
Summary
Healthcare professional with over 6 years of experience in medical claims, benefits coordination, and third-party liability claims. Proven track record of leading high-performing teams for over 2 years, enhancing accuracy, and streamlining processes. Recognized for motivating teams and optimizing workflows to ensure every claim is processed effectively.
Overview
8
8
years of professional experience
Work History
Senior Claim Analyst
Alpine Health
Dallas
01.2021 - Current
- Managed over 250 complex claims weekly, emphasizing benefits accuracy and timely adjudication.
- Recovered more than $150K annually from third-party liability cases.
- Trained and mentored four junior team members, increasing first pass claim accuracy by 18%.
- Collaborated with IT, provider relations, and mail room to eliminate processing bottlenecks.
Claims Supervisor
Horizon Health Services
Dallas
07.2019 - 01.2021
- Led team of 7 claim processors and support staff in high-volume, deadline-driven environment.
- Developed new review workflow, reducing rework by 22% and enhancing cycle time KPIs.
- Facilitated weekly meetings to align team goals with performance benchmarks.
- Coached staff through policy changes, ensuring smooth transitions.
- Acted as escalation point for high-value claims and interdepartmental disputes.
Claims Adjudicator
Vanguard Insurance
Dallas
01.2017 - 06.2019
- Reviewed and adjudicated over 200 claims weekly for Medicaid, Medicare Advantage, and employer-sponsored plans.
- Collaborated with pharmacists, billing staff, and providers to ensure claim accuracy.
- Reduced denial rate by 15% through proactive reviews and education on provider coding errors.
- Supported monthly compliance audits and contributed to internal quality assurance reporting.
Education
High School Diploma -
Saint Gregory High School
Chicago, ILSkills
- Claims adjudication and TPL management
- Staff training and development
- Performance evaluation
- Process optimization
- Verbal and written communication
- Health plan compliance
- Claims platforms: Facets, QNXT, Amisys
- Microsoft Excel, Outlook, SharePoint
- Reporting tools: Tableau, Power BI
Custom
- Promoted to supervisor after 18 due to strong leadership and peer to peer mentorship
- Introduced a targeted QA tracking system that helped reduced internal errors by 20%.
- Acted as interim department lead during senior leadership transition held team performance steady.
Timeline
Senior Claim Analyst
Alpine Health
01.2021 - Current
Claims Supervisor
Horizon Health Services
07.2019 - 01.2021
Claims Adjudicator
Vanguard Insurance
01.2017 - 06.2019
High School Diploma -
Saint Gregory High School
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