Kamisha Barnwell
Greenwich ,CT
Summary
Experienced Claims Specialist with 7+ years of experience in medical claims processing, adjudication, and benefits analysis. Demonstrated ability to review complex claims, determine eligibility and coverage, and apply plan guidelines to approve, deny, or pend claims. Strong knowledge of insurance policies, claim investigation procedures, and documentation requirements. Recognized for accuracy, attention to detail, and the ability to manage high-volume workloads while meeting productivity and quality goals.
Overview
10
10
years of professional experience
Work History
Senior Claims Specialist
Meritain Health an Aetna
Remote
02.2025 - Current
- Analyzed complex claims to determine eligibility and compliance with company policies.
- Led cross-functional teams to streamline claims processing workflows, enhancing efficiency and accuracy.
- Mentored junior staff on best practices for claims adjudication and customer service excellence.
- Implemented process improvements that reduced claim resolution times and enhanced customer satisfaction ratings.
- Evaluated potential exposure levels associated with high-value complex claims to ensure adequate reserves were established in accordance with established guidelines and industry best practices.
- Reviewed policy documents thoroughly before initiating coverage assessments so as not only identify gaps but also accurately interpret terms conditions applicable each situation faced when handling specific incidents reported insured individuals businesses seeking assistance under their respective insurance plans offered managed our organization.
- Assisted in adjusting ICD-10 codes to align with procedure codes. Supported team members in maintaining accurate coding practices. Contributed to the overall efficiency of coding processes.
DSNP Navigator/ Claims Specialist
United Healthcare Inc
04.2020 - 01.2025
- Reviewing member claims, determining allowable benefits, investigate losses and analyze documents
- Serving as the initial and main point of contact with customers filing insurance claims
- Adhere to the company's and customer facilities code of conduct and policies with great understanding HIPPA
- Ensure medical records are assembled in standard order
- Adhere to the EMR standards, practices and policies
- Identified trends in claim patterns, providing actionable insights for process improvements and risk mitigation strategies
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes
- Negotiated successful settlements with clients, ensuring a mutually beneficial outcome for all parties involved
- Assisted clients throughout the entire lifecycle of their claim, from initial filing to final settlement or denial determination
- Collaborated with cross-functional teams to develop best practices for claim handling procedures
- Supported internal audit initiatives by providing detailed documentation of claims handling procedures as required for compliance purposes
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims
Data Entry Specialist
City MD
Yonkers, NY
01.2018 - 03.2020
- Analyze data to identify trends and opportunities for improvement
- Verified data files prior to entry to maintain high data accuracy.
- Corrected data entry errors to prevent duplication or data degradation.
- Compiled, verified accuracy, and sorted information to prepare source data for computer entry.
- Compared transcribed data with source document to detect and correct errors.
- Checked for accuracy by verifying data and records.
- Eliminated discrepancies in data to prevent degradation issues.
- Compiled data and reviewed information for accuracy prior to input.
Receptionist
Northside Hospital
Smyrna, GA
05.2016 - 12.2018
- Greeted hospital visitors in a friendly and professional manner
- Assisted patients with prescription refills, billing issues and insurance questions
- Independently scheduled and registered patients by operating a multi-line telephone system to ensure minimal waiting time while maximizing the ward's efficiency
- Ensured accuracy of patient information as well as completeness of co-pays, charges, and insurance information
- Supported both the clerical and administrative department of the clinic
- Coordinated with the safety officer, nursing and social work department to maintain all the visitation restrictions and regulations
Education
General Educational Development Certificate - undefined
Skills
- Expert Microsoft Suites
- Time Management
- Problem Solving
- Excellent verbal & written communication
- Fast Learner
- Conflict Resolution
- Attention to Detail
- Settlement management
- Claims investigation
- Claims analysis
- Verbal communication
- Data entry mastery
- Data entry and review
- Rapid 10-key data entry
Timeline
Senior Claims Specialist
Meritain Health an Aetna
02.2025 - Current
DSNP Navigator/ Claims Specialist
United Healthcare Inc
04.2020 - 01.2025
Data Entry Specialist
City MD
01.2018 - 03.2020
Receptionist
Northside Hospital
05.2016 - 12.2018