Keisha Baxter
Gibsonton,FL
Overview
25
25
years of professional experience
Work History
Grievance Appeals Specialist
Elevance Health
Tampa, FL
06.2008 - Current
- Generates written correspondence to customers such as members, providers and regulatory agencies.
- Collaborated with fellow team members to manage large volume of claims.
- Performs research to respond to inquiries and interprets policy provisions to determine the extent of company's liability and/or provider's/beneficiaries entitlement.
- Identifies barriers to customer satisfaction and recommends actions to address operational challenges.
- Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
Claims Examiner
Anthem
Tampa, FL
05.2004 - 05.2008
- Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on maximum impact.
- Complete adjustments to claims and ensure the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
- Communicate extensively with members and providers regarding adjustments to resolve claims errors/issues, using clear language to ensure understanding
- Learn and leverage new systems and training resources to help apply claims processes/procedures
- Reviewed and processed disability claims in accordance with relevant standards.
Property Claims Adjuster
Fl No Fault
Tampa, FL
06.1999 - 04.2004
- Interviewed and corresponded with claimants, witnesses, police and physicians.
- Review litigated complaints for proper handling
- Ensure that all assigned claims are resolved timely, reserved accurately, and handled fairly.
- subrogation claims
- resolving coverage questions
- taking statements
- establishing clear evaluation and resolution plans for claims
Education
Bachelor of Science -
St Petersburg College
St Petersburg Fl12-2024
Skills
- Compare facts gathered during the investigation against the policy to determine coverage of claim, extend or deny coverage as appropriate
- Verbal and Written Communication expertise
- 10 years of experience of Medicaid and Medicare policies and regulations
- Experience working with Microsoft Teams
- Pursue timely coverage analysis and communicate with insured based on application of policy information
- Identify subrogation opportunities
- Keep effective diary management system to ensure all claims are handled timely
- All Lines Adjuster 620 lis
- Detailed oriented and self starter with strong organization skills
- Flexible with accuracy and the ability to work with minimum supervision
- Handle claims to the line Claim Handling Standards
- Established clear evaluation and resolution plans for claims
Timeline
Grievance Appeals Specialist
Elevance Health
06.2008 - Current
Claims Examiner
Anthem
05.2004 - 05.2008
Property Claims Adjuster
Fl No Fault
06.1999 - 04.2004
Bachelor of Science -
St Petersburg College
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