Analytical and proactive professional specializing in claims processing and process improvement. Known for strong collaboration and problem-solving skills, contributing to impactful solutions that enhance client engagement and operational processes.
Overview
14
14
years of professional experience
Work History
Consultant
Florida Blue
Jacksonville, FL
06.2011 - 10.2025
Collaborated with teams to establish claim rules, ensuring accurate application of benefits for Medicare claims
Leveraged 3 years of call center experience to assist member clients and provider clients with effective first contact resolution techniques.
Utilized SQL and TOAD data tools to generate impact reports, assisting leaders with inventory analysis and trend assessment
Collaborated with IT teams on various projects, ensuring deadlines were met.
Collaboration with compliance team to ensure adherence to CMS standards and regulations
Implemented process improvements for cross-functional projects that led to $500k in Medical Cost savings
Facilitated resolution of Medicare member complaints through effective email correspondence
Analyzed client needs to recommend tailored healthcare solutions.
Collaborated with cross-functional teams to enhance service delivery processes.
Supported project management efforts by coordinating timelines and resources.
Evaluated program effectiveness through data analysis and feedback collection.
Provided advice on operational processes, business development initiatives, organizational changes and other areas of improvement.
Analyzed complex information from multiple sources to identify patterns or trends.
Managed multiple projects simultaneously ensuring timely completion within budget constraints.
Education
Nation High School
Jacksonville, Fl
05.2009
Skills
Claims processing
SQL programming
Data analysis
Process improvement
Project management
Effective communication
Trend assessment
Problem solving
Conflict resolution
Customer relationship management
Client engagement
Team collaboration
Continuous improvement
Subject matter expert
Business presentation
Reports and documentation
Analytical thinking
Integrity and honesty
Trend analysis
Business analysis
Attention to detail
Time management
Verbal and written communication
Analysis & evaluation
Processes and procedures
Accomplishments
LEAD - Launching Employees into Active Development