Kahlema Tillman
Jonesboro,GA
Summary
Detail-oriented Claims Specialist with expertise in managing claims processes, policy interpretation, negotiation, and settlement strategies that enhance operational efficiency. Strong analytical and fraud detection skills, combined with comprehensive knowledge of insurance regulations, support effective communication and problem-solving. Capable of managing multiple claims simultaneously while ensuring high satisfaction among all stakeholders.
Overview
2
2
years of professional experience
4
4
years of post-secondary education
Work History
Claim Specialist
Everise
Jonesboro, GA
12.2025 - 01.2026
- Analyzed and approved non-auto adjudicated claims, maintaining accuracy and compliance with medical necessity guidelines to support effective claims processing.
- Reviewed and adjudicated routine claims, ensuring adherence to established guidelines and timely resolution.
- Processed claims using internal systems and customer databases to facilitate accurate and timely claim resolution.
- Conducted eligibility verification and identified discrepancies in claims submissions.
- Applied cost containment measures to assist in the claim adjudication process.
- Routed and triaged complex claims to Senior Claim Benefits Specialist for further review.
- Proofed claims to determine appropriate guidelines, coding, and member identification processes.
- Communicated with clients to gather necessary information for claims processing.
Claim Benefit Specialist
Sagility
Jonesboro, GA
11.2023 - 09.2024
- Analyzed and approved claims that could not be auto adjudicated, ensuring accuracy and compliance with medical necessity guidelines.
- Reviewed and adjudicated routine claims in accordance with established guidelines.
- Verified eligibility and identified discrepancies in claims submissions to ensure compliance and accuracy.
- Conducted eligibility verification and identified discrepancies in claims submissions.
- Triaged complex claims for Senior Claim Benefits Specialist review, facilitating timely resolution.
- Routed and triaged complex claims to Senior Claim Benefits Specialist for further review.
- Proofed claims to determine appropriate guidelines, coding, and member identification processes.
- Assisted team members in resolving complex claim issues through collaboration.
- Maintained detailed records of claims and interactions in database systems to support accurate reporting and audits.
Education
High School Diploma -
Canarsie HS
Brooklyn, NY 09.2004 - 06.2008
Skills
- Claims Processing
- Claims review
- Claims processing
- Attention to detail
- Time Management
- Fast-paced production
- Microsoft Office
- Analytical Thinking: Strong ability to think logically and solve problems effectively
- Team Collaboration: Ability to work independently and as part of a team in a production environment
- Communication: Excellent oral and written communication skills
Timeline
Claim Specialist
Everise
12.2025 - 01.2026
Claim Benefit Specialist
Sagility
11.2023 - 09.2024
High School Diploma -
Canarsie HS
09.2004 - 06.2008