Marcella Hobson
Memphis,TN
Summary
Quality-focused insurance professional with 7+ years of experience in claims review, policy interpretation, and regulatory compliance within healthcare and insurance environments. Proven ability to audit documentation, identify errors and compliance risks, and ensure adherence to internal standards and regulatory guidelines. Strong analytical and reporting skills with a background supporting audit readiness and process improvement. Member of the National Society of Leadership and Success (NSLS).
Overview
7
7
years of professional experience
Work History
Claims Representative II
Trustmark Benefits
01.2025 - Current
- Reviewed insurance claims for accuracy, completeness, and compliance with policy provisions and regulatory guidelines
- Identified processing errors, documentation gaps, and compliance risks; escalated findings according to internal procedures
- Applied policy interpretation to ensure consistent and accurate claim determinations
- Maintained detailed documentation to support quality reviews, audits, and regulatory requirements
- Met established quality benchmarks while adhering to procedural and compliance standards
- Collaborated with internal teams to resolve discrepancies and improve claim accuracy and consistency
Customer Service Associate (Insurance Operations)
NTT DATA Insurance Services
10.2021 - 12.2023
- Reviewed insurance and claim inquiries using internal systems, documentation review, and research to ensure accurate resolution
- Evaluated claim issues submitted via phone, email, and ticketing systems for procedural and compliance adherence
- Documented claim actions and outcomes to support audit trails and regulatory requirements
- Researched claim denials and approvals and prepared clear written summaries for resolution
- Tracked, logged, and escalated recurring issues to support quality improvement
Medical Assistant
Eye Surgery Group
Memphis, TN
12.2020 - 09.2021
- Maintained electronic health records to ensure clinical accuracy and regulatory compliance
- Documented procedures and post-operative instructions in accordance with healthcare standards
- Supported clinic operations through documentation control, inventory management, and compliance practices
Patient Care Advocate
Accredo Specialty Pharmacy
07.2019 - 09.2020
- Reviewed eligibility documentation, prescriptions, and enrollment criteria to ensure compliance with specialty pharmacy program guidelines
- Maintained accurate system records to support audit readiness, patient safety, and regulatory standards
- Interpreted program requirements and communicated compliance-related information to stakeholders
- Identified and escalated adverse events, duplicate therapies, and allergy warnings per established protocols
- Supported operational workflows through detailed documentation and data accuracy
Education
Associate of Arts & Sciences - Criminal Justice
University of Phoenix
Diploma - Medical Assistant
Concorde Career College
Memphis, TNHigh School Diploma - undefined
Raleigh Egypt High School
Memphis, TNSkills
- Quality Assurance & Audits
- Compliance Monitoring & Risk
Identification - Claims Review & Accuracy Validation
- Policy Interpretation & Appeals Support
- HIPAA & Insurance Regulations
- Documentation & Audit Readiness
- Root Cause Analysis
- Data Review & Reporting
- Process Improvement
- Microsoft Excel, Word, Outlook
- Remote Workflow Management
Leadership & Honors
National Society of Leadership and Success (NSLS) Inducted Member
- Completed leadership development coursework
- Participated in goal-setting and team leadership programs
- Earned Certificate of Leadership Excellence
Timeline
Claims Representative II
Trustmark Benefits
01.2025 - Current
Customer Service Associate (Insurance Operations)
NTT DATA Insurance Services
10.2021 - 12.2023
Medical Assistant
Eye Surgery Group
12.2020 - 09.2021
Patient Care Advocate
Accredo Specialty Pharmacy
07.2019 - 09.2020
Diploma - Medical Assistant
Concorde Career College
High School Diploma - undefined
Raleigh Egypt High School
Associate of Arts & Sciences - Criminal Justice
University of Phoenix