Demika Jackson
Summary
Detail-oriented and results-driven Claims Representative with 15+ years of experience supporting medical claims processing, healthcare documentation, compliance, and customer service operations. Experienced in reviewing claims-related documentation, auditing records for accuracy, maintaining HIPAA compliance, and coordinating with healthcare providers, patients, and internal departments to ensure timely claim resolution. Skilled in claims review, data entry, quality assurance, regulatory compliance, and case documentation. Proven ability to manage high-volume workloads while maintaining accuracy and meeting performance standards.
Overview
23
23
years of professional experience
Work History
QA/QC Admin III
Maximus
Tyler
10.2025 - 04.2026
- Conducted quality reviews and audits of calls, cases, correspondence, and transactions to ensure compliance and enhance service delivery.
- Monitored employee performance for accuracy, compliance, and adherence to policies, contributing to improved operational standards.
- Evaluated customer interactions and completed quality scorecards to identify training needs and enhance customer satisfaction.
- Provide coaching and feedback to staff and management.
- Identify trends, errors, and training opportunities.
- Maintain quality reports, databases, and documentation.
- Reported compliance issues to management for review.
- Participate in calibration meetings and quality improvement initiatives.
- Ensure confidentiality and proper handling of sensitive information.
- Support appeals, investigations, and corrective action processes.
Claims Supervisor
Pearl Interactive Network
12.2020 - 11.2024
- Reviewed and validated healthcare-related documentation to ensure accuracy and compliance with claims processing requirements.
- Conducted quality audits and record reviews to identify discrepancies and maintain data integrity.
- Ensured compliance with HIPAA regulations and organizational policies when handling confidential medical information.
- Coordinated medical appointments and maintained detailed documentation to support claims and eligibility processes.
- Assisted with claims-related documentation review and issue resolution.
- Investigated and resolved documentation discrepancies through collaboration with internal teams and healthcare stakeholders.
- Maintained accurate records and supported regulatory audits with 100% compliance.
- Supervised claims processing to ensure adherence to company standards.
- Trained team members on claims procedures and customer service best practices.
- Reviewed and approved payments made on insurance claims within established guidelines.
Claims Coordinator
Service Wire
01.2017 - 03.2020
- Processed and reviewed insurance claims for accuracy and compliance.
- Coordinated communication between clients, adjusters, and management teams.
- Maintained detailed records of claim activities in company systems.
- Maintained confidential records and verified documentation accuracy.
- Reviewed data for completeness and compliance with company and regulatory standards.
- Investigated and resolved record discrepancies while maintaining detailed documentation.
- Processed high-volume transactions with accuracy and timeliness.
- Assisted with reporting, auditing, and compliance activities.
Claims Specialist
Sutherland Global
04.2007 - 12.2016
- Reviewed and processed claims in accordance with company policies.
- Communicated with clients to gather necessary information for claims resolution.
- Investigated claims to determine coverage and eligibility based on policy terms.
- Processed and reviewed documentation with a high degree of accuracy and attention to detail.
- Maintained electronic records and ensured compliance with federal regulations and company policies.
- Resolved documentation issues and followed up to obtain missing information.
- Managed multiple priorities while meeting productivity and quality standards.
- Utilized tracking systems to document and monitor case status.
Medical Claims Administrator
Oschner Hospital
08.2003 - 08.2007
- Supported medical claims documentation, audits, and record reviews for trauma and emergency cases.
- Coordinated with providers, patients, and Health Information Management teams to support claims processing activities.
- Verified medical documentation accuracy to facilitate timely claim submission and reimbursement.
- Maintained patient medical records and ensured HIPAA-compliant handling of protected health information.
- Assisted with healthcare revenue cycle operations and compliance reporting.
- Utilized EMR systems to manage patient records and support claims-related documentation
Education
Associate of Science -
Bossier Parish Community College
Bossier City, LASkills
- Medical Claims Processing & Adjudication Support
- Claims Review & Documentation Verification
- HIPAA & Healthcare Compliance
- Claims Auditing & Quality Assurance
- Customer Service & Claim Resolution
- Medical Records Management
- Data Entry & Record Accuracy
- Regulatory Compliance
- Healthcare Documentation Standards
- EMR & HRIS Systems
- Problem Resolution & Investigation
- Microsoft Office Suite
- Data analysis
Timeline
QA/QC Admin III
Maximus
10.2025 - 04.2026
Claims Supervisor
Pearl Interactive Network
12.2020 - 11.2024
Claims Coordinator
Service Wire
01.2017 - 03.2020
Claims Specialist
Sutherland Global
04.2007 - 12.2016
Medical Claims Administrator
Oschner Hospital
08.2003 - 08.2007
Associate of Science -
Bossier Parish Community College