Erica Kay Johnson
Surprise,AZ
Summary
Claims Examiner with 15+ years of experience in healthcare and insurance sectors. Expertise in analyzing complex claims and reviewing medical records to ensure compliance with policy guidelines. Proven track record of delivering timely and accurate determinations, enhancing operational efficiency.
Overview
2026
2026
years of professional experience
Work History
Claims Examiner
Lincoln Financial Group
10.2021 - Current
- Evaluate short-term disability claims by reviewing detailed medical records, employer statements, and physician notes.
- Collaborate with case managers, nurse consultants, and physicians to render timely and accurate determinations.
- Communicate with claimants and healthcare professionals to gather required documentation and clarify information.
- Identify and escalate suspicious or non-compliant claims.
- Ensure compliance with policy provisions and regulatory guidelines.
Claims Analyst & Case Management Specialist
Cotiviti (formerly HMS)
02.2021 - Current
- Conduct thorough post-payment claims reviews for accuracy and compliance.
- Document findings in detailed reports; support audit processes.
- Demonstrate strong attention to detail, problem-solving, and time management.
Group Installation & Enrollment Coordinator I
Blue Cross Blue Shield of Nebraska
06.2015 - 01.2021
- Managed end-to-end enrollment for small group health plans.
- Ensured accuracy in quoting, enrollment setup, renewals, and terminations.
- Communicated regularly with brokers and internal teams to maintain service standards.
Collections Specialist
Law Office of Brumbaugh & Quandahl
01.2013 - 09.2014
- Managed legal collections and claim disputes for multiple clients.
- Handled garnishments, lawsuits, and judgment preparation.
Recovery Specialist Insurance Services
West Asset Management
11.2007 - 12.2013
- Recovered overpaid insurance claims by coordinating with providers.
- Maintained detailed spreadsheets and documentation.
Patient Placement Coordinator
Ancillary Care Management
12.2005 - 06.2008
- Facilitated patient discharge and home care transitions.
- Managed intake authorizations, DME placement, and provider coordination.
Customer Service Representative II (CSC II)
Blue Cross Blue Shield of Nebraska
- Responded to provider and member inquiries regarding claims and benefits.
- Interpreted EOBs, processed dental and RX claims, and documented all interactions.
- Demonstrated multi-queue training and a high first-call resolution rate.
Education
Certificate - Conflict Resolution & Leadership
01.2009
Certificate - Psychiatric Technology
Vatterott College
Coursework - Criminal Justice Administration
Bellevue University
Skills
- Microsoft Office (Word, Excel, PowerPoint, Access), Lotus Notes, AS400, HIPAA Compliance Tools
- Strong written and verbal communication, multitasking in high-volume environments, contract negotiation and service agreements, familiarity with medical coding and billing terminology
Core Competencies
Claims Adjudication & Resolution, Medical Records Analysis, Policy Compliance & Fraud Detection, Case Management & Documentation, Customer Service Excellence, Knowledge of ICD-9/10, CPT, HIPAA, Microsoft Office, Lotus Notes, AS400, Legal & Insurance Collections
Timeline
Claims Examiner
Lincoln Financial Group
10.2021 - Current
Claims Analyst & Case Management Specialist
Cotiviti (formerly HMS)
02.2021 - Current
Group Installation & Enrollment Coordinator I
Blue Cross Blue Shield of Nebraska
06.2015 - 01.2021
Collections Specialist
Law Office of Brumbaugh & Quandahl
01.2013 - 09.2014
Recovery Specialist Insurance Services
West Asset Management
11.2007 - 12.2013
Patient Placement Coordinator
Ancillary Care Management
12.2005 - 06.2008
Customer Service Representative II (CSC II)
Blue Cross Blue Shield of Nebraska
Certificate - Conflict Resolution & Leadership
Certificate - Psychiatric Technology
Vatterott College
Coursework - Criminal Justice Administration
Bellevue University
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