JAKAYLA ROBY
Summary
Medical Claims Specialist with 4 years of experience in processing and adjudicating medical claims, proficient in healthcare and insurance knowledge. Skilled in client communication and adept at resolving claim discrepancies to maximize reimbursement. Demonstrates strong organizational abilities and utilizes electronic claims management systems to ensure accuracy and efficiency.
Overview
4
4
years of professional experience
Work History
Medical Claims Specialist
Signify Health
12.2022 - 09.2025
- Reviewed and analyzed claim submissions for accuracy and completeness.
- Communicated with healthcare providers to resolve discrepancies and inquiries.
- Handled phone and written inquiries regarding pre-approval requests, reconsiderations, or appeals.
- Performed claim rework calculations to ensure proper adjustments.
- Processed insurance payments while maintaining accurate documentation of all transactions.
- Developed strong relationships with healthcare providers to facilitate efficient information exchange regarding patient eligibility and benefits coverage.
- Identified opportunities for cost savings by analyzing medical billing patterns across various departments.
Claims Specialist
Labcorp
Remote
05.2021 - 11.2022
- Resolved claim issues by effectively communicating with policyholders, providers, and third parties.
- Enhanced efficiency in claim processing through collaboration with various internal departments.
- Generated detailed reports outlining claim status, payments, and denials for management review.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Processed and recorded new policies and claims.
- Posted payments to accounts and maintained records.
Skills
- Claims Processing
- Healthcare Knowledge
- Insurance Knowledge
- Conflict Resolution
- Regulatory Knowledge
- Problem-Solving
- Confidentiality
- Time Management
- Teamwork and collaboration
- Multitasking Abilities
- Computer proficiency
- Data entry
- Insurance claims
- Verbal and written communication
- Documentation
- Customer service
Timeline
Medical Claims Specialist
Signify Health
12.2022 - 09.2025
Claims Specialist
Labcorp
05.2021 - 11.2022