Darrian L. Jones
Palm Bay,FL
Summary
Results-driven appeals specialist recognized for enhancing operational efficiency through thorough analysis and strategic collaboration. Proven ability to create training resources that elevate team performance and compliance adherence while successfully resolving complex appeals in a fast-paced environment.
Overview
21
21
years of professional experience
Work History
Appeals Specialist
BCBS NC
Durham, North Carolina
03.2022 - Current
- Conducted thorough reviews and analyses of appeals to uphold compliance with regulatory requirements.
- Implemented strategies to enhance precision in appeal resolution processes.
- Engaged with cross-functional teams to streamline processes for effective resolution of complex cases.
- Developed training resources to improve understanding of appeals processes and policies for new employees.
Order Filler/Order Picker
Walmart
Melbourne, Florida
05.2026 - 07.2026
- Filled and dispensed online orders with product accuracy, enhancing customer experience at pick-up. Prepared merchandise for packaging, prioritizing order precision and timely delivery. Consulted with customers to address concerns and offered suitable product substitutions, improving customer satisfaction. Located items efficiently, maintaining focus on accurate order fulfillment. Executed order filling processes with a detail-oriented approach, prioritizing order accuracy and customer satisfaction.
- Received orders and prepared them for shipment by selecting items from shelves, packing boxes, labeling, and loading onto delivery trucks.
Intake Specialist / Representative
BCBS of North Carolina
Durham, North Carolina
09.2014 - 03.2022
- Received and responded to authorization requests from hospitals, physicians, vendors, facilities, and members, ensuring compliance with timeliness standards while determining authorization requirements and member eligibility for requested services.
- Monitored daily queues to ensure compliance with payer-specific authorization requirements and departmental productivity standards.
- Collaborated with clinical staff to ensure accurate entry and delivery of information and authorization requests for administrative approvals and medical necessity reviews.
- Delivered quality customer service by addressing patient inquiries and resolving issues through professional communication. to all patients and customers through prompt and courteous professional communication.
- Utilized internal resources to identify and implement effective solutions for clients, leveraging computer systems, online resources, and business partner relationships.
- Demonstrates excellent call handling skills, patience and respect with complex and non-complex calls while processing transactions accurately.
- Processes admission notifications and/or authorization requests.
Night Manager/Auditor
Quality Inn (Formerly Holiday Inn Express)
Raleigh, North Carolina
03.2006 - 09.2014
- Reviewed front office accounting records for accuracy and compiled daily summaries of financial information to ensure accurate hotel financial records.
- Monitored room revenue, occupancy percentages, and other front office operating statistics.
- Prepared daily summaries of cash, check, and credit card activities to provide clear insight into hotel financial performance.
- Updated guest accounts with room charges and taxes, ensuring all transactions were accurately posted by front office cashier.
- Ran End of day process / Night audit process on the Property management software.
Education
Associate in Applied Science - Human Services Technology
Wake Technical Community College
Raleigh, NCSkills
- Key skills: well-spoken and confident phone skills, such as operating multiple call phones, use of a headset, working a help desk, call center experience, familiarity with computer applications such as Microsoft Office tools, databases and Windows / Macintosh operating systems
- Regulatory compliance
- Process improvement
- Appeal resolution
References
REFERENCES AVAILABLE UPON REQUEST
Timeline
Order Filler/Order Picker
Walmart
05.2026 - 07.2026
Appeals Specialist
BCBS NC
03.2022 - Current
Intake Specialist / Representative
BCBS of North Carolina
09.2014 - 03.2022
Night Manager/Auditor
Quality Inn (Formerly Holiday Inn Express)
03.2006 - 09.2014
Associate in Applied Science - Human Services Technology
Wake Technical Community College