KELSIE THOMAS
Montgomery,AL
Summary
Adept at navigating complex insurance regulations and enhancing claim accuracy, my tenure at UnitedHealth Group honed my claims analysis and conflict management skills. Achieved a 97% accuracy rate in bill review, underscoring my attention to detail and problem-solving prowess. Excel in engaging customers and driving solutions in healthcare insurance.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Supplemental Health Claims Analyst
UnitedHealth Group
11.2022 - Current
- Ensured compliance with regulatory requirements by implementing robust claim payment procedures.
- Performed claims systems utilization and capacity analysis.
- Successfully executed FACETS, On Base and SBM applications.
- Maintain data integrity.
- Conducted random quality inspections on claims.
- Teamed up with functional area leaders and SMEs to assess impact areas and develop appropriate solutions.
- Engineered claim processes to ensure compliance with legal requirements.
- Led market conduct and financial exam activities for Claim Ops.
- Evaluate and audit claims adjudication for diverse products such as Disability, Life Insurance, Accidental Death & Dismemberment in the context of Workplace Solutions.
- Corrected existing process shortfalls ensuring compliance with regulations.
Appeals Analyst
UnitedHealth Group
02.2019 - 11.2022
- Reviewed and adjudicated workers compensation medical claims.
- Facilitated the collection of needed documents from providers to guarantee accuracy in medical claims.
- Resolved medical state disputes efficiently.
- Processed HCFA and UB claims efficiently.
- Ensured accuracy in handling mediation requests from healthcare providers.
- Maintained exceptional accuracy throughout operations.
- Coordinated with auditors along with team ensuring achievement of production targets.
- Independently managed and executed claims analysis process for Secura client.
Investor Accounts Technician
Alabama Housing Finance Authority
07.2012 - 02.2019
- Compiled month-end data to maintain balanced revenue.
- Managed account settings to onboard new investors.
- Collaborated with closing agents, trustees, and borrowers.
- Managed invoice reconciliation for state fund accounts in Alabama.
- Analyzed financial data from various sources in order to provide meaningful insights into business performance.
Education
BACHELOR OF HEALTHCARE MANAGEMENT -
SOUTH UNIVERSITY
08-2025
HIGH SCHOOL DIPLOMA -
CENTRAL HIGH SCHOOL
05.2010
Skills
- Policy investigations
- Conflict management
- Multitasking
- Claims adjustment
- Attention to detail
- Interpersonal and written communication
- Claims analysis
- Complex Problem-solving
- Sourcing and compiling information
- Insurance regulations
- Analytical Proficiency
- Strong Customer Engagement in Health Care
Affiliations
- Certified Life Coach (CLC) from the Life Coach Institute
Certification
- Life Coaching Certification, International Coach Federation
Timeline
Supplemental Health Claims Analyst
UnitedHealth Group
11.2022 - Current
Appeals Analyst
UnitedHealth Group
02.2019 - 11.2022
Investor Accounts Technician
Alabama Housing Finance Authority
07.2012 - 02.2019
BACHELOR OF HEALTHCARE MANAGEMENT -
SOUTH UNIVERSITY
HIGH SCHOOL DIPLOMA -
CENTRAL HIGH SCHOOL
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