Jasmine Jackson
Milton
Summary
Detail-oriented Claims Processor skilled in adjudicating Medicare and Medicaid claims through comprehensive analysis of financial data, benefit plans, and coordination of benefits. Knowledgeable in ICD-10, HCPCS, CPT codes, and medical terminology. Acts as primary liaison among management, personnel, clients, and vendors while ensuring client confidentiality and maintaining high standards of service.
Overview
17
17
years of professional experience
Work History
Claims Examiner II
UST Healthproof
Milton, FL
02.2026 - Current
- Reviewed UST Healthproof medical claims for coverage, coding, and payment accuracy.
- Examined claim documentation against plan rules and provider records to validate coverage and payment eligibility.
- Determined claim eligibility using health benefits, policy terms, and authorization details.
- Applied plan provisions to ensure appropriate handling of claims, facilitating timely adjudication.
- Reviewed health claims files for accuracy and compliance with UST Healthproof policies, ensuring proper claim processing.
Claims Processor
Highmark Health
05.2025 - 01.2026
- Determined payment or denial for each Medicaid claim in HRP based on established rules and processes.
- Reviewed processed claims and inquiries to identify necessary corrective actions, including claims adjustments
- Determined if claim information is complete and correct
- Took corrective action steps using enrollment, benefit, and historical claim processing information
- Took the corrective action steps using enrollment, benefit, and historical claim processing information
- Resolved claim edits, reviewed history records, and determined benefit eligibility for services
Appeals Specialist
Global Medical Response
08.2024 - 02.2025
- Developed and implemented standardized procedures for handling appeals cases, improving department efficiency and consistency.
- Maintained high levels of accuracy in all written correspondence, ensuring clear communication with relevant stakeholders during the appeals process.
- Developed strong relationships with healthcare providers, insurance companies, and regulatory agencies to facilitate successful outcomes in the appeals process.
- Cultivated relationships with healthcare providers, insurance companies, and regulatory agencies to achieve successful appeal outcomes.
- Handled high-stress situations professionally, ensuring prompt and accurate processing of appeals under tight deadlines and heavy caseloads.
Claims Processor
NTT Data Services
10.2020 - 08.2024
- Adjudicate BCBS Medicare claims with complete end to end, accurate and timely claims review; perform final decision making, overpayments/adjustments, and interpretation of claims relative to Benefit Plan.
- Understood intricacies of processing medical claims across diverse healthcare specialties, ensuring accurate and efficient claim adjudication.
- Researched schedules of benefits, identifying HCPCS/CPT/ICD 10 procedure codes, diagnosis codes, and provider information to facilitate claims adjudication.
- Ensured compliance with all applicable regulations by maintaining strict adherence to HIPAA guidelines and company protocols when handling sensitive patient information.
Claims Examiner
Change Healthcare
10.2017 - 01.2020
- Adjudicated BCBS claims with accountability, accuracy, critical thinking and timely filing.
- Adhered to SOPs and SLAs for quality control, facilitating increased contract opportunities with BCBS.
- Consistently adhere to SOP's and SLA's for quality control, which contributes to taking on more contracts with BCBS.
- Manually produced medical records requests for each claim, while performing follow-up actions.
- Managed verbal and written inquiries from insurance providers and customers, ensuring timely resolution and customer satisfaction.
- Maintained records and generated monthly reports using Excel, supporting data accuracy and operational insights.
- Record keeping and produced reports with excel spreadsheets on a monthly basis.
Administrative Specialist (Senior)
90 Work/Medical Foster Care
06.2015 - 01.2017
- Served as a senior administrative specialist responsible for implementing and administering a variety of administrative tasks, direct business relations, document management, quality control, application protocol, and maintaining equipment tracking records.
- Provided calendar management, schedule of meetings, document preparation, and travel arrangements.
- Prepared financial spreadsheets, correspondence, and memos.
- Maintained monthly budget of $5,000.00 for inventory.
- Coordinated calendar management, scheduled meetings, prepared documents, and arranged travel.
- Created and maintained an electronic file system and paper files.
Employment Security Representative
Department of Economic Opportunity
10.2013 - 01.2015
- Call center representative and provided support for unemployment claims and compensation.
- Researched and analyzed unemployment claim processes to identify areas for improvement.
- Processed over 50 telephone inquiries daily, ensuring accurate and timely support for unemployment claims.
- Maintained accuracy and processed disbursements.
- Researched and analyzed claim processes.
- Recorded daily call logs to ensure accurate tracking of inquiries.
Claims Processor
Xerox State Healthcare
08.2009 - 04.2013
- Researched and provided claims support to clients, third party insurers, and medical professionals, ensuring timely resolution of inquiries.
- Researched and provided claims support for clientele, third party insurances, and medical doctors.
- Generated reports, reconciled and ensured accuracy of medical claims and disbursements.
- Processed and researched 1,000+ medical billing and claims biweekly, maintaining accuracy and compliance with regulations.
- Resolved issues involving customer complaints and claim adjudications.
- Investigated overpayments and fund requirements.
- Conducted audits and monthly reconciliations, enhancing quality control and identifying discrepancies in claims.
- Analyzed claims for accuracy, proper account charges, coding, and compliance within Florida statutes and agency guidelines logging and reporting any deficiencies and material weaknesses to senior management.
Education
Medical Coding Certification -
Allied Health Institute
Tallahassee, FLSkills
- Claims Adjudication
- Claim eligibility determination
- HIPAA compliance
- Critical Evaluation / Quality Review
- Accuracy and Precision
- Transactions reconciliation
- Medical terminology knowledge
- Records/Database Management
- FACETS/HRP/SALESFORCE/WORKFLOW PLUS
- Continuous learning mindset
- Effective communication
Timeline
Claims Examiner II
UST Healthproof
02.2026 - Current
Claims Processor
Highmark Health
05.2025 - 01.2026
Appeals Specialist
Global Medical Response
08.2024 - 02.2025
Claims Processor
NTT Data Services
10.2020 - 08.2024
Claims Examiner
Change Healthcare
10.2017 - 01.2020
Administrative Specialist (Senior)
90 Work/Medical Foster Care
06.2015 - 01.2017
Employment Security Representative
Department of Economic Opportunity
10.2013 - 01.2015
Claims Processor
Xerox State Healthcare
08.2009 - 04.2013
Medical Coding Certification -
Allied Health Institute