Selinda Scott
Jacksonville,FL
Summary
Dedicated professional with a history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Highly effective at collaborating and working with peers, customers, and other stakeholders. Known for efficiency and proactive, goal-oriented planning.
Overview
16
16
years of professional experience
Work History
Operations Analyst
Elevance Health
Cary, NC
11.2018 - Current
- Reviewed, researched, investigated and triaged appeals to determine their correct status
- Researched claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status, prior to initiation of appeal process
- Reviewed and analyzed provider requests to investigate the outcome of claim payment denials
- Worked with business partners to determine root cause and appropriate resolution
- Identify trends and emerging issues and report and recommend solutions
- Remediated impacted claims
- Received and responded to state or federal regulatory complaints related to claims
- Managing complex system issues
- Maintained knowledge of benefits claims processing, claims principles, and HIPAA regulations
- Met or exceeded productivity, procedure, and financial metrics.
Medical Claim Processor II
Beacon Health Options
Morrisville, NC
08.2015 - 07.2018
- Analyzed complex claims based on contracted benefits and policies
- Reviewed and verified demographic and claims data for accuracy
- Reviewed member benefit contracts for PPO, EPO, HMO, and ASO plans
- Priced out of network claims to utilize Burgess and Fair Health applications
- Assisted with special projects and high-priority clients
- Reported policy changes and company policies affecting customer satisfaction
- Followed internal standards and examining guidelines to prevent claims processing errors
- Reprocessed, adjusted and recouped claims to correct processing errors
- Processed claims according to established quality and production standards to handle demand with high accuracy.
Claims Representative
Independent Management Services
Tampa, FL
10.2014 - 03.2015
- Entered claim data, verified deductibles, coinsurance, and copayments
- Adjudicated claims based on contractual terms
- Assisted with special pricing projects for senior management
- Performed timely insurance follow up with billing offices and clients
- Resolved escalated claim issues for members and providers
- Offered friendly and efficient service to all customers, handling challenging situations with ease
- Documented calls following departmental policies
- Exceeded goals through effective task prioritization and a great work ethic
- Used critical thinking to break down problems, evaluate solutions and make decisions
- Performed duties following all applicable standards, policies, and regulatory guidelines to promote a safe working environment.
Bill Review Auditor
MyMatrixx Healthcare
Tampa, FL
07.2013 - 04.2014
- Processed claims following multi-state regulations and guidelines
- Reviewed procedure and diagnosis codes to ensure compliance
- Analyzed pended claims for utilization management services
- Analyzed pended claims for updates or system pricing error trends
- Resolved appeals through evaluation of contracts and state regulations
- Interfaced with clients and providers to resolve routine inquiries
- Researched work flows to ensure timely and accurate claims adjudication
- Evaluated accuracy and quality of data entered into the agency management system
- Calculated adjustments, premiums, and refunds
- Carried out day-to-day duties accurately and efficiently
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
Technical Claims Specialist
Coventry Healthcare
Tampa, FL
12.2009 - 02.2012
- Processed claims following multi-state regulations and guidelines
- Reviewed procedure and diagnosis codes to ensure compliance
- Analyzed pended claims for utilization management services
- Analyzed pended claims for updates or system pricing error trends
- Resolved appeals through evaluation of contracts and state regulations
- Interfaced with clients and providers to resolve routine inquiries
- Researched workflows to ensure timely and accurate claims adjudication
- Evaluated accuracy and quality of data entered into the agency management system
- Calculated adjustments, premiums, and refunds
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
Bill Review Team Lead
MyMatrixx Healthcare
Tampa, FL
02.2008 - 09.2009
- Analyzed and processed complex claims
- Researched and resolved provider appeals for payment
- Resolved escalated internal and external inquiries
- Ensured unit achieved production and quality metrics of pended claims
- Prepared daily reports of claim statistics for senior management
- Trained processors and ensured processing standards were achieved
- Coached team members in techniques necessary to complete job tasks
- Established open and professional relationships with team members to achieve quick resolutions for various issues
- Evaluated employee skills and knowledge regularly, training and mentoring individuals with lagging skills.
Education
Associate of Science - Healthcare Management
SNHU - Manchester, NH
12-2025
Skills
- Analytical Thinking
- Attention to Detail
- Interpersonal Skills
- Adaptability and Flexibility
- Problem-Solving
- Organizational Skills
- Excellent Communication
- Teamwork and Collaboration
- Process updates
- Root Cause Analysis
- Decision-Making
- Trend tracking
Timeline
Operations Analyst
Elevance Health
11.2018 - Current
Medical Claim Processor II
Beacon Health Options
08.2015 - 07.2018
Claims Representative
Independent Management Services
10.2014 - 03.2015
Bill Review Auditor
MyMatrixx Healthcare
07.2013 - 04.2014
Technical Claims Specialist
Coventry Healthcare
12.2009 - 02.2012
Bill Review Team Lead
MyMatrixx Healthcare
02.2008 - 09.2009
Associate of Science - Healthcare Management
SNHU - Manchester, NH
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