Jacinta Hinds - Claims Specialist

Summary

Claims Specialist with 4years of experience in healthcare operations, compliance, claims review, billing support, and customer service within fast-paced environments. Expert in claims adjudication, HIPAA compliance, Medicaid regulations, and provider support. Proven track record of reducing claim denial rates by 25% and improving turnaround time (TAT) by 30% through rigorous validation of mileage, level of service, eligibility, and documentation accuracy. Adept at identifying Fraud, Waste, and Abuse (FWA) indicators and resolving complex claim discrepancies to ensure audit readiness and financial accuracy.

Overview

6

years of professional experience

1

Certification

Work History

Claims Specialist

Confidential Healthcare Client

Remote

02.2020 - 05.2026

Processed an average of 150+ transportation and healthcare claims daily with 99% accuracy, ensuring strict adherence to Medicaid requirements and client-specific guidelines.
Reduced claim denial rates by 25% within 6 months by implementing a proactive validation process for mileage, trip data, authorizations, and supporting documentation prior to submission.
Resolved 300+ denied, rejected, or pended claims monthly by conducting root cause analysis and coordinating with transportation providers and internal teams to correct discrepancies.
Identified and escalated potential Fraud, Waste, and Abuse (FWA) indicators, contributing to improved compliance monitoring and reduction of payment errors.
Improved average turnaround time (TAT) for claims processing from 5 days to 3 days by optimizing workflows and leveraging Excel reporting tools for trend analysis.
Maintained 100% audit readiness by ensuring all claims records and Explanation of Payment (EOP) documentation were accurate, complete, and HIPAA compliant.

Education

Associate of Science - Health Informatics

Seminole State College of Florida

Sanford, FL

Skills

Claims Processing: Claims Adjudication, Denial Management, Appeals, Reconciliation, EOP Validation
Compliance & Regulations: HIPAA, Medicaid Requirements, State-Specific Guidelines, FWA Detection, Audit Readiness
Technical Skills: HCPCS, ICD-9, ICD-10, Condition Codes, Microsoft Excel (Pivot Tables, VLOOKUP), Claims Management Systems, Root Cause Analysis, Provider Relations, Data Integrity, Time Management

Typing Speed: 35 wpm

Accomplishments

Reduced transportation claim denial rates by 25% by strengthening pre-adjudication validation processes for eligibility, mileage accuracy, authorizations, and supporting documentation.
Improved claims turnaround time by 30% through workflow optimization, root cause analysis, and proactive resolution of denied, rejected, and pended claims.
Maintained 99% claims processing accuracy while ensuring full compliance with Medicaid regulations, HIPAA standards, and client-specific billing requirements in a high-volume environment.