LE'CHELL NEWCOMBE
Saint Ann,MO
Summary
Healthcare operations professional with strong claims analysis, compliance, and care coordination experience in high-volume payer settings. Resolve complex cases across 30+ systems, apply No Surprises Act and reimbursement rules, and use automation tools and AI pilots to improve workflow efficiency, documentation quality, and timely member support.
Overview
1
1
Certification
6
6
years of professional experience
Work History
Advocate4me Sr
UnitedHealth Care
05.2022 - Current
- Managed high-volume caseload of benefits, claims, clinical program referrals, provider coordination, and regulatory compliance activities, ensuring timely and accurate resolutions.
- Resolve an average of 55+ complex healthcare cases daily utilizing 30+ enterprise applications while maintaining quality and compliance standards.
- Achieve and maintain quality performance metrics exceeding 98% through accurate claims research, documentation, and issue resolution.
- Navigate 30+ enterprise healthcare applications to research, analyze, and resolve complex claims, eligibility, reimbursement, and care coordination issues.
- Analyze high-cost cases, including ESRD, NICU, hemophilia, and catastrophic claims, using specialized claims review methodologies to ensure billing accuracy and policy compliance.
- Apply No Surprises Act regulations and reimbursement methodologies to support accurate payment determinations and member protections.
- Coordinate daily with providers, care teams, and operational stakeholders to facilitate timely resolution of healthcare access and reimbursement issues.
- Coordinated with providers, clinical teams, and internal stakeholders to facilitate urgent documentation transfers.
- Leveraged automation tools, including Macro Express and RPA solutions, to streamline workflows and minimize manual processing.
- Selected for enterprise AI pilot initiatives evaluating Microsoft Copilot and other generative AI technologies to improve operational efficiency and documentation quality.
- Tracked performance metrics to evaluate workflow efficiency.
- Highlighted significant achievements in performance and compliance.
- 55 cases daily
- 98% quality score
- 10+ provider interactions daily
- 30 systems
Human Resources Operations Assistant
Amazon
06.2020 - 12.2020
- Ensured employee record accuracy and supported leave-of-absence administration for high-volume workforce, adhering to FMLA and organizational policies.
- Audited, maintained, and safeguarded confidential employee information using HRIS platforms.
- Remote
Senior Benefits Consultant
GoHealth
03.2021 - 10.2021
- Educated Medicare-eligible consumers on coverage options, eligibility requirements, and plan benefits, ensuring regulatory compliance.
- Achieved strong quality assurance performance within a highly regulated sales environment.
- Collaborated remotely to support team initiatives and ensure effective communication.
Education
High School Diploma -
Cahokia High School
Cahokia, IL05-2009
Bachelor of Science - Healthcare Administration, Health Information Management
Capella University
Minneapolis, MNSkills
- Claims analysis
- Medicare expertise
- Healthcare operations management
- Regulatory compliance
- Care coordination
- Process improvement
- Workflow optimization
- Lean Six Sigma
- Data integrity assurance
- Claims data analysis
- Healthcare data management
- Claims processing software
- Medicare claims processing
- Healthcare technology integration
- Healthcare analytics tools
- Healthcare project management
- Authorization processes
- Generative AI applications
- AI-driven communication
- Robotic process automation
- Workflow automation techniques
- Microsoft 365 proficiency
- Population health management
- Health information management
- Root cause analysis
- Robotic process automation
Personal Information
Title: Healthcare Operations | Health Information Management | Process Improvement
Certification
- Lean Six Sigma Green Belt
- Missouri Health Insurance Producer License
Accomplishments
- Selected for Enterprise AI Pilot Team evaluating Microsoft Copilot and Generative AI solutions to improve documentation workflows and operational efficiency.
- Lean Six Sigma Green Belt focused on process optimization, waste reduction, and continuous improvement methodologies.
- Navigate 30+ healthcare applications and databases to investigate and resolve complex operational and claims-related issues.
- Licensed Missouri Health Insurance Producer with Medicare, commercial plan, and regulatory compliance expertise.
Timeline
Advocate4me Sr
UnitedHealth Care
05.2022 - Current
Senior Benefits Consultant
GoHealth
03.2021 - 10.2021
Human Resources Operations Assistant
Amazon
06.2020 - 12.2020
High School Diploma -
Cahokia High School
Bachelor of Science - Healthcare Administration, Health Information Management
Capella University