LaDonna Pearson
Birmingham,AL
Summary
Detail-oriented claims specialist with 15+ years in healthcare. Proven track record of enhancing claim processing efficiency and ensuring compliance through effective problem-solving and attention to detail.
Dedicated claims processing professional known for exceptional verbal communication and customer service. Expertise in training and mentoring junior specialists, leading to improved team performance and streamlined workflows.
Experienced with analyzing and processing diverse claims accurately and efficiently. Utilizes strong investigative skills and attention to detail to ensure fair settlements. Track record of maintaining compliance with industry regulations and providing excellent customer service.
Professional claims specialist with strong record in handling and resolving complex claims efficiently. Adept at analyzing data, identifying discrepancies, and providing solutions that drive positive outcomes. Effective team collaborator with focus on achieving results and adapting to evolving requirements. Skilled in negotiation, customer service, and regulatory compliance, consistently ensuring accuracy and fairness.
Overview
16
16
years of professional experience
Work History
Provider/Member Maintenance & Claims Specialist
SS&C Technologies
06.2010 - 02.2026
- Analyzed complex claims to ensure compliance with company policies and regulatory requirements.
- Collaborated with cross-functional teams to resolve escalated claims efficiently and effectively.
- Trained new staff on claims processing systems and best practices for accuracy in documentation.
- Implemented process improvements that enhanced claim turnaround times and reduced error rates.
- Developed detailed reports to track claim trends and identify areas for operational enhancement.
- Led initiatives to streamline workflows, resulting in increased team productivity and efficiency.
- Mentored junior specialists, fostering professional growth and knowledge sharing within the team.
- 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.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Achieved performance targets consistently through attention to detail, effective time management, and strong decision-making abilities.
- Analyzed claim documents to ensure accuracy and compliance, mitigating risk of financial loss.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Ensure compliance with HIPPA and industry standards while handling confidential provider and member data.
- Contributed to workflow improvements that increased accuracy and reduced claim reprocessing.
- Experienced healthcare specialist with 15+ years at SS&C Technologies, supporting provider/ member maintenance and claims processing. Skilled in managing provider data resolving, and ensuring compliance with healthcare regulations.
- Recognized for accuracy, efficiency, and long-term dedication to delivering high-quality service for providers and customers.
Education
No Degree - General Studies
Jefferson State Community College
Birmingham, AL03-2002
High School Diploma -
Huffman High School
Birmingham, AL05-2001
Skills
- Claims processing
- Verbal communication
- Microsoft office
Languages
English
Timeline
Provider/Member Maintenance & Claims Specialist
SS&C Technologies
06.2010 - 02.2026
No Degree - General Studies
Jefferson State Community College
High School Diploma -
Huffman High School