KyChelle Miller
Parkton,NC
Summary
Detail-oriented and highly organized Claims Specialist with eight years of experience handling medical, property, and disability insurance claims. Proven ability to work independently in remote settings, process high claim volumes, and ensure accuracy and compliance with regulatory standards. Excellent communication, investigative, and customer service skills, with a strong knowledge of insurance systems and HIPAA regulations.
competencies- Remote Work Expertise.
- Claims Investigation and Processing
- Medical/Insurance Terminology.
- ICD-10 / CPT Codes.
- HIPAA compliance.
- Customer Service and Conflict Resolution.
- Data Entry & Case Management
- Microsoft Office, Salesforce, Guidewire, and Epic.
- Multi-State Claims Handling.
- Appeals and Denials Management
Overview
2026
2026
years of professional experience
1
1
Certification
Work History
Senior Claims Specialist
ABC Insurance Group
Memphis, Tennessee
09.2020 - 08.2025
- Processed 40 to 60 medical and disability claims daily, adhering to state and federal guidelines.
- Managed full claim lifecycle from intake to adjudication, including documentation and appeals.
- Conducted investigations on complex claims using internal databases and external resources.
- Achieved 98% accuracy in claim determinations, ensuring compliance with regulations.
- Trained over five new hires on claims software and remote work protocols.
Claims Specialist
Healthfirst Insurance
Memphis, Tennessee
05.2018 - 06.2020
- Reviewed and analyzed submitted claims for completeness, eligibility, and coding accuracy.
- Communicated with providers, members, and vendors to obtain necessary information.
- Utilized Salesforce and proprietary platforms to track and report claims status.
- Processed appeals and handled escalations in collaboration with legal and compliance teams.
Claims Processor
national lifecare group
Memphis, Tennessee
Education
Criminal Justice
Strayer University
Raleigh, NC12-2025
Skills
- Claims Systems: Guidewire, Epic, Facets, Salesforce
- Communication Tools: Slack, Zoom, Microsoft Teams
- Office Software: Microsoft Word, Excel, Outlook
- Remote Tools: VPN, Citrix, Secure File Transfer Systems
- Claim management
- Data analysis
- Team collaboration
- Claims investigation
- Claimant Interviewing
- Claims analysis
Certification
- Certified Claims Professional (CCP) – National Association of Claims Professionals (NACP)
- HIPAA Compliance Certification
Timeline
Senior Claims Specialist
ABC Insurance Group
09.2020 - 08.2025
Claims Specialist
Healthfirst Insurance
05.2018 - 06.2020
Claims Processor
national lifecare group
Criminal Justice
Strayer University
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