Jamie Harrison
Jacksonville,FL
Summary
Specialist in healthcare claims processing with a strong background in audit management and training facilitation. Effectively resolved complex provider inquiries and escalated claims issues, contributing to enhanced team performance and operational improvements across multiple systems.
Overview
15
15
years of professional experience
Work History
Senior Advisor, Strategic Provider Services
Florida Blue / Blue Cross Blue Shield of Florida
Jacksonville, USA
10.2020 - 04.2026
- Acted as subject matter expert for complex claims and reimbursement issues, providing guidance that improved resolution outcomes.
- Resolved escalated provider, agent, and internal service issues, enhancing service delivery and support.
- Functioned as a UAT subject matter expert for new system implementations, providing training for employees on four newly deployed systems.
- Created and implemented SOPs, DTPs, and knowledge base articles to streamline processes and improve access to information.
- Provided onboarding and hands-on training for new hires; facilitated four 8-week classes.
- Audited daily production work for approximately 30 employees.
- Analyzed Commercial, Medicare, and BlueCard claims for discrepancies.
Inbound Call Center Agent
Florida Blue / Blue Cross Blue Shield of Florida
Jacksonville, USA
06.2018 - 10.2020
- Resolved complex provider inquiries involving claims, benefits, eligibility, and reimbursement.
- Triaged provider appeals, claim reconsiderations, and dispute requests to expedite resolution.
- Investigated Commercial, Medicare, and BlueCard claims.
- Collaborated with internal teams to effectively resolve escalated claim issues, enhancing overall case management.
- Reviewed medical records and supporting documentation related to claim denials.
- Educated providers on claims processing and appeal procedures, improving understanding and compliance.
Medical Records Unit
Florida Blue / Blue Cross Blue Shield of Florida
Jacksonville, USA
10.2011 - 06.2018
- Processed and maintained medical records to facilitate claims review, audits, and appeals.
- Reviewed documentation to ensure completeness and compliance with regulatory standards.
- Organized and retrieved records to support claims investigations effectively.
- Ensured compliance with HIPAA regulations to protect patient information.
Education
High School Diploma -
Skills
- Claims Processing
- Provider Appeals
- Claim Denials
- Medical Records Review
- Production Auditing
- Customer service
- System implementation
- Team collaboration
- Time management
- Training facilitation
- Provider Relations
- Team Training
- Quality Assurance
- Escalation Management
- Customer Service
- Audit management
- SOP development
- Problem solving
- Effective communication
Systems
APT • Diamond • Quest • Convergence X • PAIS • Siebel • MCG • CMCA • ITS • IMS • ICS • DSO • EIP • Blue² • PeopleSoft • Provider Connect • Customer Connect • Care Connect • COB Profile •Claims Connect• Availity • JIVA • EWOC • BlueWeb (RTM) • Microsoft Office
Timeline
Senior Advisor, Strategic Provider Services
Florida Blue / Blue Cross Blue Shield of Florida
10.2020 - 04.2026
Inbound Call Center Agent
Florida Blue / Blue Cross Blue Shield of Florida
06.2018 - 10.2020
Medical Records Unit
Florida Blue / Blue Cross Blue Shield of Florida
10.2011 - 06.2018