Summary
Overview
Work History
Education
Skills
Certification
Timeline
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Kelsey McLeod

Tallahassee,Florida

Summary

Accomplished insurance professional with extensive experience in pharmacy claims adjudication, demonstrating a strong ability to efficiently assess and process claims while upholding all standards of accuracy and compliance. Proven expertise in administrative insurance functions, complemented by a commitment to continuous improvement through ongoing training in healthcare analytics. This combination of skills enhances the capacity to support data-driven pharmacy operations and drive organizational success. Passionate about leveraging analytical insights to optimize processes and improve outcomes within the insurance sector.

Overview

2026
2026
years of professional experience
1
1
Certification

Work History

Claims Adjudicator

Optum
05.2022 - Current
  • Processed prescription claims and insurance verifications remotely for accurate, timely adjudication.
  • Communicated with patients and healthcare providers on medication availability and claim disputes.
  • Utilized pharmacy software to submit and resolve claims for standard and specialty medications.
  • Reviewed denied claims, identified root causes, and collaborated with insurers to reprocess issues.
  • Maintained comprehensive records of transactions and updated patient accounts per pharmacy standards.
  • Adhered to HIPAA regulations, ensuring patient confidentiality during claims processing.

Lead Certified Technician

Publix Pharmacies
08.2019 - 02.2022
  • Processed medication orders and verified prescriptions while ensuring pharmacy workflow efficiency.
  • Managed adjudication of insurance claims, including verification and follow-up on rejections.
  • Collaborated with pharmacists to deliver medication therapy management and address patient concerns.
  • Trained and mentored new pharmacy technicians on adjudication processes and technology systems.
  • Assisted in maintaining inventory by placing orders and aligning stock levels with regulations.
  • Provided customer service by addressing inquiries about insurance coverage and medication pricing.

Compounding Pharmacy Technician

WellPack Pharmacy and Compounding
2019 - 2019
  • Supported pharmacy team by efficiently organizing supplies, cleaning workspaces, and assisting with daily operations as needed.
  • Optimized inventory management, reducing waste and ensuring availability of necessary supplies.
  • Conducted quality control tests on compounded medications, ensuring safety and efficacy for patients.
  • Collaborated with pharmacists to provide high-quality patient care and tailored medications.

Boys Department Lead

Old Navy, Gap
2018 - 2019
  • Mentored new hires within the department, providing guidance on company policies and procedures as well as job-specific tasks.
  • Boosted overall employee morale by fostering a positive work environment and promoting open communication.
  • Oversaw efficient inventory stocking and supply rotation.
  • Set up displays and trained employees on current promotions.
  • Delegated tasks efficiently, maximizing the use of resources while maintaining high-quality output from the team members.
  • Collaborated with other departments to improve interdepartmental communication, enhancing overall organizational effectiveness.

Education

CpHT - Pharmacy

Lively Technical College
Tallahassee, FL
01.2019

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Lincoln High School
01.2014

Skills

  • Microsoft Office Suite
  • Pharmacy management systems
  • Prior authorizations
  • Customer service and support
  • HIPAA compliance
  • Billing and coding
  • Professional communication
  • Time management
  • Leadership skills
  • Medicare and Medicaid knowledge
  • Remote work and virtual communication
  • Attention to detail
  • Claims processing
  • Client relationship management
  • Government policy regulations
  • Data acquisition
  • Research and data analysis
  • Claims processing documentation
  • Data verification
  • Claims management
  • Client rapport

Certification

  • Florida Registered Pharmacy Technician– Active
  • National Pharmacy Technician Certification– Active
  • Florida Immunization Technician– Active
  • Pharmacy Data Analyst (In Progress)
  • Pharmacy Claims Analyst (In Progress)

Timeline

Claims Adjudicator

Optum
05.2022 - Current

Lead Certified Technician

Publix Pharmacies
08.2019 - 02.2022

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Lincoln High School

Compounding Pharmacy Technician

WellPack Pharmacy and Compounding
2019 - 2019

Boys Department Lead

Old Navy, Gap
2018 - 2019

CpHT - Pharmacy

Lively Technical College

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