Selina Milledge
Jacksonville
Summary
Extensive experience in the healthcare industry, recognized for strong organizational, analytical, and interpersonal
skills. Builds collaboration and trust across internal teams and external partners through effective communication and
problem-solving. Delivers impactful presentations, supporting retail operations, and demonstrating comprehensive
knowledge of multi-line claims processing. Committed team player, thrives in dynamic, service-oriented environments.
Overview
25
25
years of professional experience
Work History
IT Business Analysis
BlueCross and Blue Shield of Florida
08.2021 - 02.2025
- Ensured business practices complied with regulatory standards, mandates, and laws.
- Make accurate recommendations for processes and procedures based on updated compliance guidelines.
- Stay up to date on Regulations, State laws, and Government Mandates.
- Advised on process improvements in alignment with compliance updates.
- Supported IT internal controls across departments and platforms.
- Created and maintained tracking logs of critical and noncritical issue identified and resolved
- Reported all discovered breaches to the appropriate authorities of the Compliance Team.
OPL Business Analysis III
BlueCross and Blue Shield of Florida
08.2007 - 08.2021
- Managed complex issue resolution and compliance oversight with vendor partners.
- Coordinated and aligned the appropriate areas in order to ensure Business Process Owners are informed on the vendor partners operational performance and adherence to compliance requirements for the business processes they support.
- Led Corrective Action Plan (CAP) initiatives and process improvement projects.
- Monitor process for identification of issues and coordinate with the vendor partner on required process improvement plans.
- Liaison with external partners in resolving major issues and vendor discrepancies
- Trained both internal teams and vendor partners on policies and processes.
- Served as SME on vendor systems integration, data feeds, and regulatory alignment.
- Managed inbound and outbound reconciliation files
- Provided executive reporting, audit responses, and documentation support.
- Support the centralized care partner issue management process to ensure timely and accurate resolution of multiple, simultaneous complex issues.
- Led Real-Time Resolution pilot and team coaching, improving member satisfaction.
- Created Standard Operation Processes (SOPs}, cue cards, and training material for ongoing knowledge transfer.
- Provided knowledge and technical expertise for the planning, managing, and implementation of process improvement plans that will educate service associates and streamline income call volume.
- Recommended improvements in processes to become more efficient and improve accuracy within the work area
- Supported Medicare Payment Demand team with issue discovery and resolution.
- Served as a direct contact for key group accounts to ensure customer satisfaction and service delivery.
- Trained temporary employees and overseen workload for Medicare Payment Demands.
- Possess strong working knowledge of Medicare compliance to assure claims are processed according their policies and procedures.
SAO Service Associate-Claim Adjuster
BlueCross and Blue Shield of Florida
03.2000 - 08.2007
- Adjudicated claims to apply credit to member’s account or to make an additional payment.
- Processed and audited claims for compliance with BCBSFL and Medicare standards.
- Led root cause analysis to resolve complex claim issues.
- Experience of BCBSFL’s professional and institutional billing payment concepts, practices, procedures and pricing.
- General knowledge of medical terminology, ICD9, ICD10, CPT and HCPCS coding.
- Knowledgeable of BCBSFL systems (IMS, Convergence X, Diamond, Siebel, Quest, CMCA, PIP, Claims Repository, PAIS, and MBSP, etc.).
- Served as SME and interview panelist for service team hiring.
- Demonstrated ability to handle management level escalated customer issues.
- Served as a Subject Matter Expert (SME) in call center to assist with complicated issues.
- Experienced in auditing of claims payments and processing.
- Educated partners on systems, policy, and claims handling procedures.
- Reviewed, evaluated and responded to operational, data and technical issues for internal and external customers to maintain reputable relationship.
- Contributed to multiple process improvement teams (Providers Audit Reconciliation Improvement Team (PARIT) and Process Improvement Team (PIT).
Education
Master of Science - Healthcare Informatics
Jacksonville University
Jacksonville, FL10.2017
Master of Business Administration - undefined
University of Phoenix
Jacksonville, FL06.2005
Bachelor - Information Systems/Business
University of Phoenix
Jacksonville, FL06.2002
Associate in Arts - undefined
Florida State College
Jacksonville, FL06.2000
Skills
- Retail experience
- User acceptance testing
- Software development life cycle
- Training program development
- Critical thinking
- Business process improvement
- Attention to detail
- Time management
- Problem-solving
- Organizational skills
- Project planning
- Analytical skills
- Vendor management
- Business intelligence
- Strategic planning
- Risk management
Timeline
IT Business Analysis
BlueCross and Blue Shield of Florida
08.2021 - 02.2025
OPL Business Analysis III
BlueCross and Blue Shield of Florida
08.2007 - 08.2021
SAO Service Associate-Claim Adjuster
BlueCross and Blue Shield of Florida
03.2000 - 08.2007
Master of Business Administration - undefined
University of Phoenix
Bachelor - Information Systems/Business
University of Phoenix
Associate in Arts - undefined
Florida State College
Master of Science - Healthcare Informatics
Jacksonville University
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