Kimberly Wells
Crestwood
Summary
Seeking Lead position within Florida Medicaid Provider Operations.
Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Overview
22
22
years of professional experience
Work History
Senior Claims Research and Resolution Professional
Humana Inc
Louisville, KY
04.2021 - Current
- Extensive experience with process improvement including root cause analysis, consensus building across multiple departments and implementation.
- Ensuring Humana’s contracts and State Statutes are adhered with respect to claims payment Integrity.Self-motivated, with a strong sense of personal responsibility.
- Ensuring that contractual obligations are met while working through barriers from a compliance perspective.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Organized and detail-oriented with a strong work ethic.
PPI Resolver/Analyst
Humana Inc
Louisville, KY
09.2009 - 04.2021
- Supplying education of Humana policy and contractual obligations to the Providers, focusing on resolution to outstanding accounts of the largest contracted Provider group consisting of 27 out-of-state healthcare institutions.
- Manage multiple Providers with unusual contracts and escalated issues involving but not limited to PPI issues, payments, overpayments, and audits.
- Contract load issues, query validation, root cause analysis.
PPNO Customer Connection Specialist, Customer Service and Claims Specialist
Humana Inc
Louisville, KY
01.2004 - 09.2009
- Research and resolution of overpayment issues through effective verbal and technology based communication.
- DOI resolution for critical inquiry correspondence.
- Mastery of CIS with accuracy and attention to detail in all systems. Expert knowledge of information to verbally articulate solutions to Providers.
- Benefit and Claims information and processing Jan 04- Sept 09.
Education
B.S. - Management
Indiana Wesleyan University
05-2009
Skills
- CAS, CRM, ARI,
- Problem-solving
- Teamwork and collaboration
- MS Office, PowerPoint, Excel
- Motivated, independent analyst with exceptional resolution rate and timely execution of tasks
- Outstanding aptitude in communication to create and maintain relationships essential to the success of Humana
- Attention to detail and accuracy of critical information with focus on favorable resolution for Humana
- Distinguished experience in successful teamwork with diversity of peers, supervisors, as well as internal and external business partners
Timeline
Senior Claims Research and Resolution Professional
Humana Inc
04.2021 - Current
PPI Resolver/Analyst
Humana Inc
09.2009 - 04.2021
PPNO Customer Connection Specialist, Customer Service and Claims Specialist
Humana Inc
01.2004 - 09.2009
B.S. - Management
Indiana Wesleyan University
AWARDS
Star Award — June 2016, January 2021, November 2022 Silver Star Award June 11, 2021 June 25, 2021, November 22, 2023, October 25, 2024 Excellence Award March 14, 2025 Commended for excellence in communication. The Star Award highlighted my distinguished performance in both the management role of hands on and technology led training of employees, as well as in relationships with customers nationwide via telephone and email., Previous positions have facilitated me the experience and education to create strong working relationships in high-stress environments.