LADENNA Edwards
Broken Arrow,OK
Summary
Detail-oriented claims professional with a background in remote claims processing, adjudication, and adjustments across multiple health plan groups. Known for accurate work, strong organization, and consistent follow-through using systems such as Health Axis, PowerStepp, AWD, and Diamond.
Overview
1
1
Certification
9
9
years of professional experience
Work History
Remote Claims Specialist
HEALTHSCOPE BENEFITS /UNITED HEALTHCARE
01.2017 - 01.2022
- Reviewed medical claims using UnitedHealthcare benefit plans and HealthSCOPE guidelines
- Processed and adjusted claims for 11 groups while addressing emails and adjustments from groups and customer service
- Processed claim adjustments through claims administration systems and internal workflows
- Interpreted plan documents, coverage rules, and explanation of benefits notices
- Utilized Heath Axis processing system, PC View, DocTrax, and Call Tracks to manage claims remotely
Claims Examiner Sr. Assoc.
DELL SERVICES /NTT DATA
01.2015 - 01.2017
- Processed claims efficiently using PowerStepp and AWD image systems, contributing to streamlined operations.
- Reviewed healthcare claims for Dell Services and NTT DATA client accounts
- Applied plan policies and claim guidelines to examiner decisions
- Investigated missing documentation and resolved claim discrepancies
- Delivered remote support to client DST, ensuring timely resolution of inquiries from home office
HC & Insurance OPS Sr. Associate/SME for the Team
DELL SERVICES
01.2014 - 01.2015
- Worked remotely for Alameda Contract, managing communications and tasks effectively.
- Answered processing questions for team and served as primary contact for client inquiries. Processed claims, collaborating with Team Lead and Supervisor to resolve client questions. Distributed training information to team and provided support to address challenges. Consistently met and exceeded quality and production guidelines while utilizing the Diamond system for client.
Customer Care-Voice Associate
DELL SERVICES
Canton, Ma
01.2014 - 01.2014
- Responded to customer inquiries using clear and professional communication.
- Assisted customers with enrollment in the Health Connector under new ACA guidelines in Massachusetts.
- Supported Dell Services clients with account updates and service requests.
- Processed service documentation and maintained accurate case records.
Remote Claims Adjustor
DELL SERVICES
01.2013 - 01.2013
- Reviewed and processed all claim types, ensuring accurate adjustments and timely payments in line with federal guidelines.
- Adjusted claims for United Healthcare in AZ as part of a special project, ensuring compliance with federal guidelines.
- Adhered to production and quality guidelines while volunteering extra hours to ensure project completion.
- Traveled to Phoenix, AZ for onsite training and transitioned to remote work.
- Submitted Excel spreadsheets to show work as it was completed.
- Worked on the Diamond system and used Excel and Microsoft 2010
Education
High School Diploma -
Broken Arrow High School
Broken Arrow, OK05-1970
Skills
- Claims management
- Claims processing
- Claims adjustments
- Claims adjudication
- Medical claims
- Health insurance systems
- Excel reporting
Certification
Medical Transcription, Medical Terminology
CLAIMS TRAINING
New procedures and coding: Paying Health Insurance Claims; Psychiatric; Chiropractic; Surgical; Extended Care; Home Healthcare; Hospital; Medical; Investigational Procedures; State Laws; DME; Medicaid; Medicare; Dental; Vision
Accomplishments
- Multiple awards for performance and for being a team player.
Timeline
Remote Claims Specialist
HEALTHSCOPE BENEFITS /UNITED HEALTHCARE
01.2017 - 01.2022
Claims Examiner Sr. Assoc.
DELL SERVICES /NTT DATA
01.2015 - 01.2017
HC & Insurance OPS Sr. Associate/SME for the Team
DELL SERVICES
01.2014 - 01.2015
Customer Care-Voice Associate
DELL SERVICES
01.2014 - 01.2014
Remote Claims Adjustor
DELL SERVICES
01.2013 - 01.2013
High School Diploma -
Broken Arrow High School