Jessica Kerkemeyer
Godfrey,Illinois
Summary
Detail-oriented Healthcare Claims Analyst with over 10 years of experience in payment integrity, provider disputes, claims auditing, and reimbursement analysis. Expertise in complex claim resolution, denial review, and root cause analysis, complemented by strong skills in quality assurance and process improvement. Experienced in KPI analysis, training, and driving cross-functional collaboration.
Overview
11
11
years of professional experience
Work History
PROVIDER DISPUTE ANALYST
EmblemHealth
04.2026 - 09.2026
- Analyzed suspected underpaid or overpaid claims using contract language, reimbursement terms, fee schedules, and processing guidelines.
- Resolved provider inquiries by reviewing Facets claim details, payment determinations, denial reasons, and supporting documentation, leading to accurate resolution paths.
- Performed root cause analysis and coordinated corrective actions with internal departments to prevent recurring claim issues.
- Recommended procedure and workflow updates that enhanced claim accuracy and strengthened quality controls.
CLAIMS TRAINER
Cognizant
09.2025 - 12.2025
- Created training schedules for Facets claims systems, processes, and best practices, enhancing onboarding for new and existing staff.
- Partnered with claims leadership to use audit results to identify trends, knowledge gaps, and targeted coaching opportunities.
- Assessed team training needs using performance metrics, audit outcomes, process changes, and employee feedback.
- Developed and updated desk-level procedures, job aids, and online tools to ensure consistent claims processing.
CLAIM SUPERVISOR
Cigna
02.2022 - 08.2025
- Led daily claims operations for 10+ Proclaim representatives, ensuring productivity, quality, and service-level compliance.
- Enhanced team performance through coaching, KPI review, and conducting corrective actions and formal PIPs.
- Developed and delivered training curricula for quality auditors, supervisors, new hires, and tenured staff, ensuring effective knowledge transfer.
- Served as Facets SME for audits, escalations, and legal inquiries, providing critical support for system updates and process training.
PROVIDER NETWORK SPECIALIST
Tabula Rasa Healthcare
04.2021 - 02.2022
- Created and maintained provider and vendor records in EZ-Cap, ensuring accuracy of demographic, contractual, and payment information to facilitate effective provider management.
- Built, maintained, and assigned fee schedules based on provider contracts, reimbursement terms, rates, and effective dates.
- Interpreted provider contracts to clarify payment provisions, rate structures, exceptions, and claim pricing impacts, supporting accurate reimbursement processing.
- Resolved pending claims through contractual review, validating setup, researching discrepancies, and coordinating with internal teams to expedite claim resolution.
CLAIMS SENIOR REPRESENTATIVE
Cigna
11.2015 - 04.2021
- Audited, corrected, and finalized Facets Prepay claims by validating claim information, payment accuracy, and program requirements.
- Tracked error codes, identified errors, and corrected amounts to enhance reporting accuracy and support trend analysis.
- Escalated complex discrepancies or claims requiring further review to appropriate Prepay team members to ensure timely resolution.
Education
Bachelor of Science - Psychology
Southern New Hampshire University
Hooksett, NH10-2026
Skills
- Provider disputes resolution
- Claims adjudication and auditing
- Payment integrity management
- Contract and reimbursement analysis
- Facets and ProClaim expertise
- EZ-CAP proficiency
- Root cause analysis
- Quality assurance processes
- KPI analysis and reporting
- Team leadership and training
- Conflict resolution strategies
- Case management techniques
- Training development initiatives
- Claims management oversight
- Claim Management
Career Break
Family Caregiving 12/2025-04/2026
Timeline
PROVIDER DISPUTE ANALYST
EmblemHealth
04.2026 - 09.2026
CLAIMS TRAINER
Cognizant
09.2025 - 12.2025
CLAIM SUPERVISOR
Cigna
02.2022 - 08.2025
PROVIDER NETWORK SPECIALIST
Tabula Rasa Healthcare
04.2021 - 02.2022
CLAIMS SENIOR REPRESENTATIVE
Cigna
11.2015 - 04.2021
Bachelor of Science - Psychology
Southern New Hampshire University