LaQuisha McCray
Fort Worth,Texas
Summary
Senior Claims Professional with robust experience in evaluating and processing complex insurance claims. Skilled in risk assessment, policy interpretation, and ensuring compliance with industry standards. Strong focus on team collaboration and achieving optimal results, adaptable to evolving business needs. Known for reliability, analytical thinking, and effective communication.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Patient Care Specialist
Cigna
02.2025 - Current
- Handle 17–25 patient calls daily regarding medication refills, prescription renewals, and prior authorizations.
- Educate patients on healthcare policies and insurance processes, ensuring compliance and satisfaction.
- Identify and resolve account discrepancies while maintaining HIPAA confidentiality.
- Document interactions in CRM systems, ensuring accuracy in patient records and communication logs.
- Analyzed workflow efficiencies, identifying opportunities for process enhancements within the care model.
- Managed complex cases by liaising between patients, providers, and insurers to resolve issues effectively.
Sr. Claim Examiner
Lincoln National Corp.
12.2023 - 02.2025
- Reviewed and adjudicated STD and medical claims, including ENT-related conditions, ensuring compliance with policy, HIPAA, and state regulations.
- Analyzed physician statements, diagnostic codes (ICD-10/CPT), and employer documentation to determine eligibility and benefit duration.
- Interpreted medical terminology and treatment plans related to ENT and other specialties to assess medical necessity and claim validity.
- Communicated with providers, employers, and claimants to clarify discrepancies and support timely, accurate claim resolutions.
- Maintained high productivity and accuracy using Microsoft Office and proprietary claims systems.
Advanced Escalation Specialist
DoorDash Corporation
08.2019 - 11.2023
- Managed 15–20 high-priority escalations daily, resolving complex customer, merchant, and delivery partner issues.
- Conducted root-cause investigations and implemented fair, compliant resolutions.
- Collaborated with cross-functional teams to streamline communication and reduce repeat escalations.
- Delivered empathetic, clear communication to de-escalate conflicts and restore customer confidence.
Education
Bachelor of Science - In Progress
Tarrant County College
Fort Worth, TX01-2029
High School Diploma -
John Glen Academy
Phoenix, AZ05.2006
Skills
- Complaint handling
- De-escalation techniques
- Goal setting and achievement
- Client retention strategies
- Complaint investigation
- Teamwork and collaboration
- Customer service
- Problem-solving
- Claims analysis
- Coverage evaluation
- Policy interpretation
- Claims processing
Certification
- Licensed Realtor- current
- HIPAA Compliance Certified
- Medical Claims Examiner & ICD-10 Coding Proficiency
- CIFA - Certified Insurance Fraud Analyst
Timeline
Patient Care Specialist
Cigna
02.2025 - Current
Sr. Claim Examiner
Lincoln National Corp.
12.2023 - 02.2025
Advanced Escalation Specialist
DoorDash Corporation
08.2019 - 11.2023
Bachelor of Science - In Progress
Tarrant County College
High School Diploma -
John Glen Academy