LaAsha Upshaw
Junction City,GA
Summary
Seasoned insurance specialist with excellent planning and problem solving abilities. Offering several years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing, high caseloads in fast-paced environments. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Solid professional standards and excellent track record of dependability. Skilled in activity planning, task management and task follow through. Able to evaluate problems, make astute decisions to effect positive change, and refocus on new priorities. Keen ability to see the “big picture” while staying abreast of business details and tight deadlines. Key skills & areas of expertise include claims processing, staff training & development, task prioritizing, and strong analytical problem solving abilities.
Overview
23
23
years of professional experience
Work History
Claims Specialist II
Lincoln Financial Group
04.2022 - Current
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Demonstrated adaptability by successfully managing a diverse range of claim types, including Accident, Hospital Indemnity, and Critical Illness.
- Participated in mentoring and job shadowing for new claims specialists, boosting team efficiency and knowledge.
Claims Adjudicator
Anthem Blue Cross Blue Shield
06.2012 - 04.2022
- Managed payment of a particularly difficult healthcare claims including insurance denials
- Set up a system that monitors delinquent accounts automatically thereby reducing research time
- Track record of managing medical payment collection activities by indulging in extensive medical billing activities
- Demonstrated expertise in acting as a liaison between medical facilities and insurance carriers including HMOs, PPOs, Medicaid, and Medicare
- First-hand experience in using coded data to produce and submit claims to insurance companies to ensure prompt payments
- Competent at reviewing and appealing unpaid and denied claims
- Documented success in effectively and efficiently translating medical procedures into codes which can be easily translated by payers and medical facilities
- Familiar with transmitting coded patient treatment information to intended recipients
- Proven record of coding treatment information using designated CPT codes and effectively reviewing medical records for accuracy and integrity.
Senior Recruiter
United States Census Bureau
02.2012 - 10.2014
- Devised and executed strategic recruitment that aligned with organizational recruitment strategies
- Facilitated full-cycle recruitment process across the organization using multiple business lines
- Sourced candidates through proven recruitment channels
- Performed sourcing, pre-screening, interviewing, and referring qualified candidates to all levels of Human Resources, Management, and Senior Leadership
- Consulted with hiring managers to understand their needs, developed recruitment strategies, and recruited top professionals
- Conducted comprehensive telephone screening interviews and overseeing the administration of pre-employment assessments
- Worked side-by-side with HR Business Partners to streamline the job requirements approval process
- Trusted to deal with highly sensitive and confidential information in a discreet and appropriate manner.
Client Relationship Specialists
Intercall
05.2011 - 06.2013
- Performed special projects and other duties as assigned or required
- Established and deepened relationships with clients by understanding their business objectives and providing exemplary support as their primary contact with customers
- Conducted on-going account meetings to communicate best practices, develop plans for expanded functionality usage, provide use case examples for leveraging key product functionality and communicate new feature releases
- Communicated frequently with clients on updates, information, concerns and suggestions
- Served as the customer’s voice within Intercall including product, marketing, professional services and sales
- Proactively anticipated customer needs and identify any potential issues
- Create recommendations and facilitate action for resolution.
Claims Analyst III
Aflac
04.2001 - 02.2011
- Handled very complex claims that included health and personal injury claims for adjudication
- Processed accounts by contacting payers and/or insured members to investigate circumstances of non-payment and negotiated payments to resolve conflicts
- Resolved outstanding Account Receivable related issues
- Assisted with preparation of ad-hoc A/R aging reports for internal and external clients where appropriate
- Reconciled payments by recording cash, checks and credit card transactions according to established procedures
- Fully understood benefits contracts, pricing processes, procedure codes, government regulations and healthcare terminology
- Knowledgeable of claims products, including the grievance and reconsideration process
- Excellent knowledge of the various operations of the organization, products and services
- Reviewed, analyzed and processed claims and handled policy related events to determine liability and entitlement.
Education
Bachelor of Arts in Healthcare Administration -
The University of Phoenix
05.2013
Skills
- Staff Development & Training
- Claims Processing And Investigation
- Verbal and Written Communication
- Cultural Diversity
- Analytical Problem Solver
- Strong Organizational Skills
- Report & Document Preparation
- HIPPA Compliance
- Electronic Medical Records
- Conflict & Grievance Resolution
- Critical Thinking
- Organizing and Prioritizing Work
- Attention to Detail
- Multitasking Abilities
- Understanding of medical terms
Professional Development
- Training & Development
- Business Law & Ethics
- Employment Laws
- Hiring the Right People
- Compensation & Benefits Management
- Developing Others
- Risk Management & Insurance
- Principles of Management
- Achieving Communication Excellence
- Fundamental of Mission Support Training
Training
Mac OS 9/10, Windows 7/Vista XP, Microsoft SharePoint, Microsoft Access, MS Office Suite (Word, Excel, Outlook, Access, PowerPoint, Project), Consolidated Personnel Reporting Online (CPRO), Electronic System of Personnel (ESP), Oracle, SAP, Microsoft Dynamics, GPR, Epic, Health Quest, ADP, Rexx
Timeline
Claims Specialist II
Lincoln Financial Group
04.2022 - Current
Claims Adjudicator
Anthem Blue Cross Blue Shield
06.2012 - 04.2022
Senior Recruiter
United States Census Bureau
02.2012 - 10.2014
Client Relationship Specialists
Intercall
05.2011 - 06.2013
Claims Analyst III
Aflac
04.2001 - 02.2011
Bachelor of Arts in Healthcare Administration -
The University of Phoenix
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