Nekeema Logan
Tampa,FL
Summary
Skilled claims processing professional with extensive experience in reviewing and validating insurance claims. Strong focus on accuracy, problem-solving, and effective communication. Known for collaborative approach and adaptability to changing needs. Proficient in claims software, data entry, and customer service. Recognized for reliability and achieving results in team environments.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Claims Processor (SME/Team Lead)
UnitedHealth Care
Indian Rocks Beach, FL
02.2022 - 01.2026
- Analyzed complex claims submitted by providers and facilities for appropriate ICD-10, CPT and HCPCS codes against charges billed.
- Researched contracts to verify if providers were in-network or out-of-network to determine how the claim would be paid.
- Reviewed documents to determine if the claim was filed timely based on CMS regulations and policy.
- Became a Subject Matter Expert (SME) based on high performance goals and metrics.
Claims Administrative Support
Progressive
Riverview, FL
07.2018 - 04.2021
- Interacted with customers and medical providers.
- Managed over 60 claim files and documents.
- Prepared weekly claim resolution reports.
- Handled phone and chat inquiries.
Medical Claims Processor
Cognizant
Tampa, FL
12.2015 - 04.2018
- Entered and adjudicated 60 plus internal and external claims in assigned work queues on a timely basis.
- Worked claim denials to determine why the claim was denied and if it needed to be overturned, adjusted, or upheld.
- If unable to resolve the claim edits based on provider details, insurance, benefits, reimbursement policies, denied the claim.
- Reviewed the different methodologies on the claim (OPS APC, DRG, IPPS, CMS, ETC) to determine if claim was paid correctly based on contracted rate.
Long-Term Disability Claims Specialist
Humana
Tampa, FL
06.2014 - 12.2015
- Managed 20 overall LTD block of claims daily including Statutory, Federal, State and other leave types while adhering to company requirements as well as ERISA.
- Provided interviews to gather additional information as well as confirm information regarding the claim.
- Requested medical records while to send to the clinical staff once all other information was obtained from claimant/employer/physician.
- Communicated with claimants, healthcare providers, and insurance partners regarding claim status and decision of approving or denying claim.
Education
Bachelor of Science - Paralegal Studies
St. Petersburg College
Clearwater, FLAssociate of Arts - Criminal Justice
St. Petersburg College
Clearwater, FLSkills
- Attention to detail
- HIPAA guideline compliance
- Insurance Verification
- CPT/ICD 10
- QNXT
- Facets
Systems Used
- ECW
- Meditech
- Kronos
- Availity
- EPIC
- Cerner
Certification
Certified Revenue Cycle Representative (C.R.C.R.)
Timeline
Claims Processor (SME/Team Lead)
UnitedHealth Care
02.2022 - 01.2026
Claims Administrative Support
Progressive
07.2018 - 04.2021
Medical Claims Processor
Cognizant
12.2015 - 04.2018
Long-Term Disability Claims Specialist
Humana
06.2014 - 12.2015
Bachelor of Science - Paralegal Studies
St. Petersburg College
Associate of Arts - Criminal Justice
St. Petersburg College