Latwainia Benjamin
Healthcare Administration Professional
Florence,SC
Summary
Accomplished healthcare administration professional with 15+ years of experience in claims and benefits in a healthcare setting. Proven ability to identify trends and implement recommendations with building customer relationships, claims process and solving diverse problems. Steps into multiple roles to accomplish demanding objectives in fast-paced environments.
Skilled in keeping operations running smoothly while satisfying customers and maintaining high service quality.
Overview
14
14
years of professional experience
Work History
Dedicated Service Consultant
Bluecross Blueshield
10.2022 - Current
- Provided information about service procedures and expected timelines .
- Assist customers with requests regarding claim denials, prior authorizations, durable equipment and adjustments
- Discussed options with clients and determined appropriate plans while attending daily meetings with assigned groups
- Documented payment details and personal information on customer accounts.
- Provide Support to external employee groups for their members while serving as primary contact for assigned groups
- Collaborate with group executive management to address employee inquires, tracking inquiries trends to analyze and make recommendations for contracted benefits modifications
Operations Analyst, Medicaid
BlueCross BlueShield
10.2021 - 10.2022
- Attended daily meetings with assigned group colleagues to discuss updates or changes to current coverage issues
Claims Research Analyst-Casualty/Fund Recovery Unit
Bluecross Blueshield
02.2018 - 10.2021
- Analyzed large volume of data to identify patterns, trends and correlations using info to obtain reimbursement for Medicaid
- Reviewed and investigate leads regarding accidents, cival cases or trauma situations and managed selected cases in pursuit of recovery
- Trained new employees on procedures and policies including liability, assignment and subrogation laws, statues of limitations and various claims processing systems
- Prepared detailed reports summarizing research findings and recommendations for further action.
- Conducted in-depth qualitative and quantitative research to identify trends and generate insights.
- Conducted post-payment reviews of paid claims while maintaining accurate electronic files on eligible Medicaid recipients
- Served as liaison between attorney, insurance adjuster, and client
Team Lead for Insurance Agents
Technekes LLC
03.2017 - 02.2018
- Coached team members in techniques necessary to complete job tasks.
- Managed 5-10 analysts and specialists including daily operations, scheduling and future workflow
- Trained new team members, oversee and processed pharmaceutical orders, government payor policies, local and national coverage determinations, CPT and ICD -10 coding, and insurance company payor policies
- Evaluated employee skills, administered cases and claims amending and revising case payment for Medicare
Senior Reimbursement Counselor-Benefits Specialist
Amerisourcebergen
10.2009 - 08.2016
- Promoted
- Built relationships with business partners while ensuring effective use of procedures in accordance with business practices and compliance with state and federal regulations
- Prioritized incoming service requests, claims and inquiries from new business coordinators, agency contracts, and internal or external partners while maintaining service levels for case assurance
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Initiated prior authorization, claims, appeals processes, and assisted in writing program standard operating procedures
- Aided physician office staff and patients to complete necessary insurance forms and program standard operating procedures
Education
Bachelor’s Degree (Anticipated 10/2024) - Healthcare Management
University of Phoenix
Tempe, AZAssociates Of Arts Degree - Healthcare Administration
University of Phoenix
Tempe, AZ10.2010
Certification - Medical Assistant
Central Carolina Technical College
Sumter, SC07.1997
Certification - Phlebotomy
Professional Training Services
Sumter SC1997
Skills
- Staff Training
- Oracle
- NextGen
- AMGEN Assist AS400
- Infopro
- Issue Resolution
- Account Management
- Arms-Pro
- Microsoft Office
- Excel
- MMIS
- TPL
- Rumba
- Iflow
Timeline
Dedicated Service Consultant
Bluecross Blueshield
10.2022 - Current
Operations Analyst, Medicaid
BlueCross BlueShield
10.2021 - 10.2022
Claims Research Analyst-Casualty/Fund Recovery Unit
Bluecross Blueshield
02.2018 - 10.2021
Team Lead for Insurance Agents
Technekes LLC
03.2017 - 02.2018
Senior Reimbursement Counselor-Benefits Specialist
Amerisourcebergen
10.2009 - 08.2016
Bachelor’s Degree (Anticipated 10/2024) - Healthcare Management
University of Phoenix
Associates Of Arts Degree - Healthcare Administration
University of Phoenix
Certification - Medical Assistant
Central Carolina Technical College
Certification - Phlebotomy
Professional Training Services
Similar Profiles
MICHELLE SERMON-DAVISMICHELLE SERMON-DAVIS
Chief Learning Officer at BlueCross BlueShield of Tennessee Inc.Chief Learning Officer at BlueCross BlueShield of Tennessee Inc.
JAMIE WILSONJAMIE WILSON
Benefit Files Analyst II (BlueChoice Operations) at BlueCross BlueShield of SCBenefit Files Analyst II (BlueChoice Operations) at BlueCross BlueShield of SC
Morgan MarzetteMorgan Marzette
Member Engagement Coordinator at BlueCross BlueShield of South CarolinaMember Engagement Coordinator at BlueCross BlueShield of South Carolina
Melvis Kimbeng TambiMelvis Kimbeng Tambi
RN Case Manager at BlueCross BlueShield MNRN Case Manager at BlueCross BlueShield MN
Trecia Bogle-LibirdTrecia Bogle-Libird
Dasher at DoorDashDasher at DoorDash