Karmen Revell
Shreveport,LA
Summary
Detail-oriented Claims Examiner skilled in managing insurance claims and resolving discrepancies. Interprets policies, verifies coverage, and negotiates settlements to enhance claims processing efficiency. Utilizes strong analytical and problem-solving skills to achieve fair resolutions.
Overview
19
19
years of professional experience
Work History
Rapid Response Claims Examiner
Allied Benefit Systems
Chicago, IL
08.2025 - Current
- Process and adjudicate high-volume healthcare insurance claims while maintaining accuracy, timeliness, and compliance with established authority levels.
- Apply healthcare regulations, client-specific policies, procedures, processing guidelines, and established requirements when reviewing and adjudicating claims.
- Research complex claims, billing discrepancies, and denials using carrier websites, databases, and available system resources to determine appropriate claim handling.
- Investigate claim issues and discrepancies, determine resolutions, and maintain documentation that supports final claim outcomes.
- Correct processing errors through reprocessing, adjustments, and recoups, ensuring complete and accurate claim documentation.
- Prioritize daily workload based on urgency, complexity, and business impact, consistently meeting productivity, quality, and turnaround expectations.
- Communicate potential processing issues and complex claim matters to appropriate internal resources for timely resolution.
Claims Adjudication Specialist
NTT Data
, Texas
10.2023 - 08.2025
- Processed and adjudicated healthcare claims, ensuring accuracy and compliance with multi-state processing requirements.
- Reviewed eligibility, patient information, and insurance coverage, facilitating accurate and timely claim determinations.
- Reviewed medical records, authorized payments, and addressed claim-related complaints and inquiries requiring research and resolution.
- Coordinated with internal and external contacts to resolve discrepancies, achieving accurate completion of assigned work.
- Researched and resolved provider-submitted discrepancies through direct communication with providers while maintaining confidentiality and data-security requirements.
- Utilized tracking systems to document, monitor, and follow up on complaints, operational issues, and outstanding claim-related matters.
- Managed multiple priorities while maintaining documentation, quality, and timely resolution requirements.
Senior Claims Technician
Blue Cross Blue Shield
Marshall, TX
06.2021 - 04.2025
- Resolved complex claims appeals and discrepancies while adhering to applicable processing guidelines and requirements.
- Collaborated with insurance agencies, providers, contracting teams, and cross-functional partners to resolve payer and claim issues and ensure timely resolutions.
- Analyzed claim data to identify trends, discrepancies, recurring issues, and opportunities for corrective action and process improvement.
- Educated providers on claim submission requirements, reducing errors and supporting accurate, timely processing.
- Supported accurate and timely resolution of complex issues requiring coordination across multiple parties.
- Developed and maintained tracking system for pending claims, enhancing visibility and follow-up.
- Maintained detailed investigation records and documented communications throughout the claim-resolution process.
Customer Service Team Lead
CenturyLink Call Center
Shreveport, LA
02.2014 - 08.2019
- Led and coached customer service staff, enhancing service quality and effectively managing escalations and conflict resolution.
- Streamlined call-handling and escalation processes, resulting in faster response and resolution times.
- Trained new team members on procedures, service expectations, and problem-resolution practices.
- Analyzed operational trends to pinpoint coaching needs and identify process improvements.
- Supported workload coordination, issue escalation, documentation, and timely resolution of customer concerns.
Technical Support Engineer
US Support Company
Shreveport, LA
05.2009 - 10.2013
- Provided technical support through phone, email, and chat while researching reported issues and documenting troubleshooting activities.
- Identified recurring issues and implemented process improvements to enhance resolution efficiency.
- Maintained accurate records of issues and troubleshooting actions to ensure effective follow-up.
- Managed multiple customer requests while ensuring service quality and precise documentation.
Reservation Team Lead
Sam's Town Casino
Shreveport, LA
01.2008 - 02.2010
- Streamlined reservation processes to reduce booking errors and improve customer satisfaction.
- Trained and mentored staff on procedures and service expectations to enhance team performance.
- Maintained detailed logs to ensure accuracy and compliance with corporate procedures.
Education
High School Diploma -
HuntingTon High School
Shreveport, LA05-2002
Some College (No Degree) - Health Information Technology
Bossier Parish Community College
Bossier City, LA09-2026
Skills
- Claims adjudication
- Claims processing
- Claims evaluation
- Claim analysis
- Medical coding
- HCPCS coding
- Health records
- HIPAA compliance
- Data validation
- Data analysis
- Process improvement
- Healthcare procedures
- Policy interpretation
- Workload prioritization
- Critical thinking
- Medical terminology
Timeline
Rapid Response Claims Examiner
Allied Benefit Systems
08.2025 - Current
Claims Adjudication Specialist
NTT Data
10.2023 - 08.2025
Senior Claims Technician
Blue Cross Blue Shield
06.2021 - 04.2025
Customer Service Team Lead
CenturyLink Call Center
02.2014 - 08.2019
Technical Support Engineer
US Support Company
05.2009 - 10.2013
Reservation Team Lead
Sam's Town Casino
01.2008 - 02.2010
High School Diploma -
HuntingTon High School
Some College (No Degree) - Health Information Technology
Bossier Parish Community College