Michael L. Branham
Brandon,FL
Summary
Insurance Professional experienced in claims resolution and customer service. Enhanced team performance through effective training and process improvements while analyzing complex claims to ensure compliance with regulations. Delivered client resolutions by interpreting policies, resolving account issues, and improving operational processes.
Overview
3
3
years of post-secondary education
19
19
years of professional experience
Work History
Interim claims supervisor
Ascension Health Care
04.2026 - Current
- Supervised claims processing team to ensure timely and accurate claim resolutions.
- Reviewed complex claims for compliance with healthcare regulations and policies.
- Implemented training sessions for staff on new claims management software.
Claims Resolution Specialist
Ascension Health Care
02.2023 - 04.2026
- Working with Texas Medicaid claims to ensure all federal and state guidelines are compliant based on program rules.
- Processed claim appeals to address discrepancies and ensure compliance with guidelines. to make all necessary changes to claims, while also pointing all Facet system issues or training opportunities.
- Wrote numerous Standard Operating Procedures and updated them to reflect current best practices.
- Working alongside with key departments thru use of Jira to fix root cause issues.
Claims Trainer
Marpai Health
Tampa, FL
04.2022 - 11.2022
- Reviewed audits from representatives and auto adjudications to identify avoidable errors and recommend process improvements.
- Researched root causes of escalations and communicated findings for processing or system updates.
- Conducted training sessions for team members to enhance skills and knowledge., creation of tools, and Created standard operating procedures for team operations to ensure consistency..
- Researching root causes to escalations and passing information for processing or system updates.
Claims Team leader
Continental Benefits
Tampa, FL
03.2020 - 04.2021
- Reviews audits from representatives, and auto adjudications to fix issues, always looking for potential avoidable errors, & areas where we can improve with the Javelina system.
- Researched root causes of escalations and provided insights for processing and system updates.
- Enhanced team morale by fostering a positive work environment and encouraging collaboration.e, pushing for production and claims knowledge raising claims Q/A’s.
Sr. Claims Processor
Continental Benefits
Tampa, FL
10.2019 - 03.2020
- Resolved escalations from clients, brokers, providers, and patients by researching issues, supporting retention of business goals.
- Coordinated special projects to meet specific deadlines to be done by a specific time. Testing new clients for issues with processing and configuration.
- Assisting team members with issues, questions, and guidance when times of need, or to step in when leadership needs are unavailable.
Claims Processor
Continental Benefits
Tampa, FL
01.2019 - 09.2019
- Resolved medical claims by approving or denying documentation, calculating benefits due, and initiating payments or composing denial letters, ensuring accurate and timely claims processing.
- Ensuring coordination of benefits between auto accidents, other accident or commercial insurance claims is done correctly per company guidelines.
- Processed insurance claims efficiently and accurately for diverse clients.
- Reviewed documentation to ensure compliance with company policies and regulations.
- Coordinated with healthcare providers to gather necessary claim information.
Claims examiner 1
Health Net Federal Services
Tampa, FL
04.2018 - 01.2019
- Collaborated with and motivated a team of 19 claim examiners to enhance productivity and accuracy, traveling locally and out of state to evaluate provider locations for claims reprocessing.
- Lead Tampa Claims Special Projects team; provide training and support for the team.
- Communicate directly with members of management and other departments to resolve claims issues.
- Engaged with management and cross-departmental teams to effectively resolve claims issues.
- Perform medical claim recoupments, account offsets & claims corrections.
- Skilled in institutional and professional claims in adjustment, recoupments, reprocessing claims using guidelines and directives, also improving changes with the work instructions.
- Managed institutional and professional claims adjustments, recoupments, and reprocessing using guidelines and directives while refining work instructions.
- Communicated consistently and proactively resolved a variety of inquiries selected by management to assist providers and company with high dollar claims.
Authorization and Appointing Representative
Health Net Federal Services
Tampa, FL
04.2016 - 04.2018
- Assisted Veterans with scheduling and rescheduling appointments with non-VA providers according to contractual standards.
- Collaborated with co-workers to achieve departmental goals, taking personal responsibility for quality and results.
- Conducted quality control; coached team members and provided actionable feedback.
Case Management
24-7 InTouch
Clearwater, FL
05.2015 - 11.2015
- Made case decisions for customer-to-customer disagreements.
- Managed client cases to ensure comprehensive support and services.
- Collaborated with multidisciplinary teams to coordinate patient care plans.
- Conducted regular assessments to evaluate client needs and progress.
Customer Service
24-7 InTouch
Clearwater, FL
03.2015 - 05.2015
- Making case decisions for the company for customer-to-customer disagreement, Conducted follow-up communications to ensure customer satisfaction., and Complaints.
- Deescalating concerned customers with attention to detail using quick judgments that are fair for both parties during trips for the host and the individual on the trip.
- Documented customer service requests and resolved problems accordingly.
- Greeted customers, answered inquiries and provided customer service.
- Developed strategies to help resolve customer service disputes.
Customer Care Specialist
Humana health insurance
Tampa, FL
01.2014 - 02.2015
- Receive, document, and resolve customer inquiries using established best practices.
- Educated customers, providers, and employers about Humana’s products, facilitating informed decision-making over the telephone.
- Handled escalated calls for personnel on my team when management were in meetings.
- Resolved escalated calls from customers during team members' absence. for personnel on my team when management was in meetings.
Billing and Enrollment Specialist
Humana health insurance
Tampa, FL
10.2013 - 01.2014
- Tracked and processed system-generated reports for enrollment and payment receipts, balancing and reconciling data while resolving discrepancies.
- Processed pharmacy claims to ensure accuracy and compliance with regulations., handling provider claims calls.
- Facilitated enrollment processes for new members in health insurance programs.
- Guided clients through eligibility requirements and application procedures.
- Coordinated outreach initiatives to educate potential members about available plans.
Senior Airman
United States Airforce
Sumter, SC
09.2007 - 09.2013
- Supervised and trained personnel in base operations, focusing on security camera systems and entry point protocols.
- Managed over 3 million dollars in equipment while deployed as a Tactical Automated Security System (TASS) administrator.
- Received Air Force and Army Achievement Medals while deployed in Afghanistan for Quick Response Teams and collaborated with the Air Force Office of Special Investigations (AFOSI).
Education
Bachelor of Science - Criminal Justice
American InterContinental University
Schaumburg, IL 08.2015 - 08.2018
Skills
- Claims management
- Regulatory compliance
- Claims auditing
- Process Improvement
- Issue resolution
- Team Building
- Leadership
- Microsoft Suite
Objective Summary
Dedicated insurance professional with 6 years of experience in claims resolution with over 12 years customer resolution. Proven knowledge of claims resolution, research, billing, adjustments, auditing, and escalations skills as a Team Lead. Analyzing account problem areas and the root causes, interpreting policies, processing case-sensitive decisions, improving processes used to build knowledge, and championing client resolutions. Frequently praised as Everyday Hero for the company, detail-oriented by my peers, I can be relied upon to help the company achieve its goals, promoting team performance and operational goals to our clients.
Timeline
Interim claims supervisor
Ascension Health Care
04.2026 - Current
Claims Resolution Specialist
Ascension Health Care
02.2023 - 04.2026
Claims Trainer
Marpai Health
04.2022 - 11.2022
Claims Team leader
Continental Benefits
03.2020 - 04.2021
Sr. Claims Processor
Continental Benefits
10.2019 - 03.2020
Claims Processor
Continental Benefits
01.2019 - 09.2019
Claims examiner 1
Health Net Federal Services
04.2018 - 01.2019
Authorization and Appointing Representative
Health Net Federal Services
04.2016 - 04.2018
Bachelor of Science - Criminal Justice
American InterContinental University
08.2015 - 08.2018
Case Management
24-7 InTouch
05.2015 - 11.2015
Customer Service
24-7 InTouch
03.2015 - 05.2015
Customer Care Specialist
Humana health insurance
01.2014 - 02.2015
Billing and Enrollment Specialist
Humana health insurance
10.2013 - 01.2014
Senior Airman
United States Airforce
09.2007 - 09.2013