Latoya Cornelius
Miramar,Fl
Summary
Dynamic and results-driven professional seeking a challenging position within an innovative organization that values creativity and technical expertise. Proven ability to leverage analytical skills to drive strategic initiatives and solve complex problems. Committed to contributing to team success while pursuing opportunities for personal and professional growth. Eager to bring a strong work ethic and a passion for excellence to a forward-thinking environment.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Claims Project Manager
UnitedHealth Group
01.2025 - Current
- Educate providers on UnitedHealth Group reimbursement policies and payment methodologies.
- Conduct in depth claim research to determine accuracy and identify root cause issues.
- Support claims processing functions including investigations, contract settlements, member eligibility, and payment accuracy.
- Partner with providers, internal teams, and advocates to resolve complex escalated claim issues.
- Ensure claim adjustments align with contract terms and reimbursement guidelines.
- Develop and implement remediation plans to address root cause failures.
National Advocacy Resolution Specialist
UnitedHealth Group
01.2020 - 01.2025
- Supported claim processing functions: investigations, settlements, eligibility verification, and payment resolution.
- Analyzed data to solve diverse issues across Community & State markets.
- Utilized multiple systems including CSP Facets, iCES, Macess, DOC360, PCRL, PROS, Appeals & Grievances Tracking System, Orbit, Odar, and ICue.
- Provided clear explanations to provider advocates using Microsoft Outlook, Excel, and Teams.
- Researched and managed subrogation claims, including recovery payables and fraud/waste/abuse coordination.
Claims Business Processor Senior Analyst
UnitedHealth Group
01.2019 - 01.2020
- Oversaw claim system processes and business rules across Community & State lines of business.
- Performed deep dive research using CSP Facets to resolve escalated provider claim issues.
- Prepared root cause analysis summaries and remediation plans using Excel.
- Collaborated with business partners to resolve issues impacting provider contracts.
- Used predictive analytics to prevent recurring system or claim-related errors.
Associate Business Analyst / PRISM-FAST
UnitedHealth Group
01.2018 - 01.2019
- Executed deep-dive analyses to resolve escalated provider issues.
- Identified process gaps and recommended innovative solutions to reduce escalations.
- Used multiple database systems including Impact, Macess, EDSS, IDARS, CareOne, Web Strat, ICue, and ISet.
- Supported predictive modeling to prevent claim processing errors.
Claims Research Team
UnitedHealth Group
01.2014 - 01.2018
- Researched and processed closed/denied simple and complex claim adjustments.
- Identified root cause issues and coordinated resolutions while maintaining HIPAA compliance.
- Ensured productivity and quality standards were consistently met.
- Provided clear claim disposition documentation via Excel reporting.
Provider Phone Representative / Subject Matter Expert
UnitedHealth Group
01.2012 - 01.2014
- Resolved provider issues on the first call whenever possible.
- Documented inquiries for trend identification and reporting.
- Advised supervisors and team leads on strategies to meet KPIs including Quality, Adherence, Service Level, and AHT.
- Set priorities and supported team members to ensure performance goals were met.
Education
Diploma - Medical Insurance Billing & Coding
National School of Technology
08-2005
Bachelor of Science - Business Administration
Johnson & Wales University
05-2004
Skills
- Systems: CSP Facets, iCES, Macess, DOC360, Impact, EDSS, IDARS, CareOne, Web Strat, Orbit, Odar, ICue, PCRL, PROS
- Tools: Microsoft Excel, Powerpoint, Word, Outlook, OneNote, Teams
- Areas of Expertise: Root Cause Analysis, Claims Adjustments, Provider Relations, Customer Service, Escalation Management, Subrogation, Predictive Analytics, Reimbursement Policy
Accomplishments
Top Performer March of 2023
Top Performer August 2023
Certification
Certificate of Completion for Community & State Hospital Adjustments April 2014
Certificate of Completion for Claims Adjuster August 2014
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Claims Project Manager
UnitedHealth Group
01.2025 - Current
National Advocacy Resolution Specialist
UnitedHealth Group
01.2020 - 01.2025
Claims Business Processor Senior Analyst
UnitedHealth Group
01.2019 - 01.2020
Associate Business Analyst / PRISM-FAST
UnitedHealth Group
01.2018 - 01.2019
Claims Research Team
UnitedHealth Group
01.2014 - 01.2018
Provider Phone Representative / Subject Matter Expert
UnitedHealth Group
01.2012 - 01.2014
Diploma - Medical Insurance Billing & Coding
National School of Technology
Bachelor of Science - Business Administration
Johnson & Wales University