BRIANNA MCMILLAN
Houston
Summary
Detail-oriented and service-driven claims professional experienced in investigating claims, analyzing coverage, and resolving complex claim issues. Skilled in negotiation, documentation, compliance, and delivering exceptional customer service. Adept at managing high volumes of claims while maintaining accuracy, compliance, and empathy.
Overview
9
9
years of professional experience
Work History
Claims Adjuster
TEKSYSTEMS
Houston, TX
07.2025 - Current
- Investigated insurance claims, coverage, eligibility, and prior authorization requirements.
- Reviewed coverage determinations and resolved claim-related discrepancies.
- Negotiate with insurance carriers to obtain approvals and resolve claim issues.
- Maintain accurate documentation while ensuring HIPAA and regulatory compliance.
Member Care Advocate
Concentrix
Houston, TX
04.2025 - 06.2025
- Managed 60+ daily member interactions involving claims, benefits, billing, and coverage.
- Investigated claim discrepancies and reviewed account histories.
- Resolved complex claims and benefit issues through research and negotiation.
- Reviewed insurance coverage and communicated claim information to members.
- Maintained detailed case documentation while meeting quality standards.
Patient Access Coordinator
Envera Health
Houston, TX
07.2023 - 09.2024
- Investigated insurance claims, denials, and authorization discrepancies.
- Reviewed insurance coverage, benefits, and prior authorization requirements.
- Coordinated with providers and insurance carriers to resolve claim issues.
- Analyzed documentation to support accurate reimbursement and claims processing.
- Maintained HIPAA-compliant records while exceeding quality expectations.
Welcome Coordinator
OAK STREET HEALTH
Brooklyn, NY
01.2023 - 07.2023
- Verified insurance eligibility, benefits, and authorization requirements.
- Resolved insurance and patient account issues through research and follow-up.
- Maintained accurate documentation and electronic records.
- Delivered exceptional customer service in a fast-paced healthcare environment.
Medical Receptionist
TEXAS EYE CENTER
Houston, TX
11.2021 - 11.2022
- Verified insurance coverage, benefits, and prior authorizations.
- Worked with insurance carriers regarding claims and coverage questions.
- Reviewed CPT coding and documentation for billing accuracy.
- Maintained organized patient and insurance records.
Medical Receptionist
GENERAL VISION SERVICES
Brooklyn, NY
01.2017 - 03.2020
- Verified insurance eligibility, benefits, and claims information.
- Processed insurance documentation and resolved account discrepancies.
- Coordinated with insurance carriers regarding coverage and billing issues.
- Managed front desk operations in a high-volume medical practice.
Education
Bachelor of Science - Nursing
Western Governors University
Salt Lake City, UT01.2028
Skills
- Claims investigation & Analysis
- Negotiation & Settlement
- Customer Service & Advocacy
- Time Management
- Problem Solving
- Attention to detail
- Microsoft Office Suite
- Adaptability & Resilience
- Documentation & compliance
Timeline
Claims Adjuster
TEKSYSTEMS
07.2025 - Current
Member Care Advocate
Concentrix
04.2025 - 06.2025
Patient Access Coordinator
Envera Health
07.2023 - 09.2024
Welcome Coordinator
OAK STREET HEALTH
01.2023 - 07.2023
Medical Receptionist
TEXAS EYE CENTER
11.2021 - 11.2022
Medical Receptionist
GENERAL VISION SERVICES
01.2017 - 03.2020
Bachelor of Science - Nursing
Western Governors University
LICENSE
Texas All-Lines Adjuster license