Kebren Jackson

ICON Consultants

01.2024 - Current

Accountable for conducting extensive research and resolving claim disputes and complaints from members, providers, and related external agencies to ensure compliance with internal and regulatory deadlines.
Examine claims processing guidelines, provider contracts, fee schedules, and system configurations to identify the root cause of potential payment errors.
Perform thorough investigations by collecting pertinent information, interviewing relevant parties, and reviewing supporting documents such as medical records, contract terms, and benefits.
Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
Strengthened client relationships by providing clear communication throughout the claims process, ensuring all parties were well-informed of progress and outcomes.
Facilitated smooth transitions between departments during claim handoff processes to ensure seamless coordination among internal teams for prompt resolution times.
Enhanced customer satisfaction by efficiently managing insurance claims processes and providing timely resolutions.
Maintained compliance with industry regulations and standards by staying current on relevant laws, policies, and best practices for handling insurance claims.

Similar Profiles