Kelly Taylor
Jackson,MS
Summary
Skilled claims processing professional with extensive experience in reviewing and validating insurance claims. Strong focus on accuracy, problem-solving, and effective communication. Known for collaborative approach and adaptability to changing needs. Proficient in claims software, data entry, and customer service.
Overview
7
7
years of professional experience
Work History
Claims Processor – Federal Employee Program
Florida Blue
Jackson, MS
10.2022 - Current
- Adjudicate high-volume claims for the Federal Employee Program (FEP), consistently exceeding GuideWell quality benchmarks and maintaining elite first-pass accuracy.
- Analyze complex medical documentation to ensure strict alignment with Plan documents and federal benefit mandates.
- Identify and document processing discrepancies to prevent financial overpayments and maintain audit readiness.
- Remote
Provider Staffing Coordinator
CareCentrix
04.2022 - 10.2022
- Managed the end-to-end Provider Staffing process for members, ensuring timely access to in-network care.
- Audited incoming referrals and clinical documentation to verify compliance with payer fact sheets and coverage guidelines.
- Facilitated seamless transitions of care by resolving authorization discrepancies between providers and the payer.
- Remote
Retention Agent
Comcast
Jackson, MS
07.2019 - 04.2022
- Performed real-time account audits to determine promotion eligibility, ensuring all billing adjustments adhered to strict regulatory policies.
- Consistently met or exceeded Quality Assurance (QA) targets through precise CRM documentation and 100% data entry accuracy.
Education
Bachelor of Business Administration - Human Resources
Strayer University
07-2026
Associate of Applied Science - Drafting and Design Technology
Hinds Community College
Skills
- Systems: Diamond, FEP Direct
- Compliance: HIPAA/PHI, FEP Service Benefit Plan guidelines, and CMS standards
- Professional Skills: Document Control, Conflict Resolution, and Technical Writing
- Claims review
- Accuracy and precision
- Claims
Timeline
Claims Processor – Federal Employee Program
Florida Blue
10.2022 - Current
Provider Staffing Coordinator
CareCentrix
04.2022 - 10.2022
Retention Agent
Comcast
07.2019 - 04.2022
Associate of Applied Science - Drafting and Design Technology
Hinds Community College
Bachelor of Business Administration - Human Resources
Strayer University