DEMIKA JACKSON
Tyler,TX
Summary
Results-driven HR and Onboarding Specialist with 15 years of experience in designing, managing, and optimizing onboarding programs and medical claims support functions. Skilled in streamlining processes, ensuring compliance with federal and state regulations—including I-9, W-4, E-Verify, HIPAA laws, and healthcare compliance standards. Experienced in claims processing, auditing, and documentation accuracy for both HR and healthcare environments. Adept at collaborating cross-functionally to deliver seamless onboarding and claims workflows, improving retention, reducing time-to-productivity, and achieving 100% compliance during audits.
Claims professional with strong experience in handling complex insurance claims and delivering impactful solutions. Skilled in claims processing, investigation, and negotiation, with keen focus on team collaboration and consistently achieving results. Adaptable and reliable, with client-centric approach and strong ability to address evolving needs effectively.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Patient Care Advocate
Sagility
11.2024 - Current
- Scheduling prescription orders
- Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines.
- Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope.
- Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements.
- Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
- Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution.
- Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.
- Handle prior authorization, reworks and refill prescriptions
- Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies.
- Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.
- Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.
- Enroll patient into copay assistance
- Process payment and assuring insurance is updated
Onboarding Specialist Supervisor
Pearl Interactive Network
12.2020 - 11.2024
- Supervised and led a team of onboarding specialists, ensuring accurate and compliant onboarding for employees and healthcare-related accounts.
- Ensured strict adherence to HIPAA and healthcare compliance laws in handling sensitive employee and patient data.
- Conducted audits and quality checks to verify data accuracy, system integrity, and claims processing readiness.
- Scheduled and managed medical appointments, ensuring accurate documentation and timely coordination between patients, providers, and claims processing teams.
- Supported HR and compliance departments with medical claims documentation and review.
- Collaborated with product, compliance, and customer success teams to ensure onboarding and claims workflows aligned with regulatory requirements.
HR Generalist
Service Wire
01.2017 - 03.2020
- Administered employee onboarding and offboarding processes, ensuring a smooth transition and compliance with internal policies.
- Maintained and updated employee records in HRIS systems, ensuring data accuracy and confidentiality.
- Assisted in payroll processing and compliance reporting.
- Ensured legal compliance with labor laws and internal regulations.
- Participated in the development and implementation of HR policies and procedures.
Onboarding Specialist
Sutherland Global
04.2007 - 01.2017
- Coordinated and executed full-cycle onboarding programs for new hires.
- Facilitated both virtual and in-person onboarding sessions.
- Ensured all required new hire documentation, including I-9, W-4, and E-Verify forms, were accurately completed and submitted on time.
- Maintained and updated employee records in HRIS systems, ensuring compliance with company policies.
Executive Administrator
Ochsner Hospital
08.2003 - 04.2007
- Maintained and organized trauma patient medical records while ensuring HIPAA compliance and legal accuracy.
- Assisted with claims documentation and audits for trauma and emergency cases.
- Scheduled and managed medical appointments, ensuring accurate documentation and timely coordination between patients, providers, and claims processing teams.
- Coordinated with Health Information Management to support timely claim submission, documentation, and retrieval.
- Supported compliance reporting, patient record integrity checks, and trauma data audits.
- Gained knowledge of CMS and Joint Commission regulations.
- Utilized EMR systems for patient record management and claims documentation.
- Supported Healthcare Revenue Cycle operations within an acute care facility (HIM experience).
Education
Associate of Science -
Bossier Parish Community College
07.2010
Diploma -
Southwood High School
05.2003
Skills
- Medical Claims Processing & Review
- HIPAA Laws & Compliance
- Claims Audits & Quality Assurance
- Healthcare Documentation Standards
- Regulatory & Legal Compliance
- HRIS Systems (Workday, ADP, Paycom, Paychex)
- Applicant Tracking Systems (ATS)
- Project Management Software (Asana, Trello)
Certification
Six Sigma Green Belt
Timeline
Patient Care Advocate
Sagility
11.2024 - Current
Onboarding Specialist Supervisor
Pearl Interactive Network
12.2020 - 11.2024
HR Generalist
Service Wire
01.2017 - 03.2020
Onboarding Specialist
Sutherland Global
04.2007 - 01.2017
Executive Administrator
Ochsner Hospital
08.2003 - 04.2007
Associate of Science -
Bossier Parish Community College
Diploma -
Southwood High School