To obtain a position of stability that can utilize my skills, knowledge, and work experience, while offering opportunities for career advancement.
Hi, I’m
Tianna Jackson
Killeen,TX
Summary
Overview
8
years of professional experience
1
Certification
Work History
Rose International, Remote
Claims Analyst
12.2022 - Current
Job overview
- Processes and adjusts professional and facility claims including, but not limited to, transplant, special handle, negotiations, and MSO according to claims processing guidelines. Maintains confidentiality rules in compliance with HIPPA guidelines.
- Pends claims as directed by departmental policies and procedures; follows up for resolution and processes pended claims immediately following a benefit / payment determination.
- Researches claims and adjustments; effectively gathers documentation needed to process claims and adjustments. Examines information including, but not limited to, authorizations, benefits, payments and denials.
- Works claims inventory from assigned queues to ensure all claims are processed within established turnaround time as directed by department policies and procedures. Consistently meets /exceeds productivity standards and accuracy standards for payment, procedural and financial.
- Performs follow-up and takes necessary actions required to resolve errors and findings assessed by the Quality Review Team.
- Identifies and reviews systematic or procedural problems with Supervisor for timely follow-up and correction.
- Completes reports / special projects to ensure prompt payment of claims.
HumanaRemote
Appeals and Grievances Specialist 3
10.2021 - 07.2023
Job overview
- Maintaining documentation associated with complaints, appeals and grievances to ensure responses are timely and in compliance with all applicable regulations and contracted timeframes
- Reviewing, researching, and documenting complaints, appeals and grievances, working with claims and internal systems applications.
- Preparing documentation and transmitting appeals/ clinical denials to the appropriate professional for review.
- Preparing and transmitting acknowledgement and final response letters.
- Ensure that all necessary clinical information is available to allow for a complete and fair review.
- Outreach as necessary to providers/ staff for clarification or additional information required.
- Prepare claims and case summary for MD review to support appropriate decision-making.
- Ensure rationales are appropriate and supported by guidelines in accordance with requirements.
- Access and review various resources to support denial or overturn denial.
- Obtain and review patient medical records from participating doctors.
- Review completed medical record worksheets submitted by clinical consultants. Communicate and discuss discrepancies with consultants to ensure the accuracy of results.
- Research, analyze and resolve complex issues and escalations related to medical record reviews, complaints and grievances and potential quality of care situations.
- Evaluate and report on possible fraud issues for investigation by the Special Investigation Unit. Partner with SIU Investigators as needed to ensure provider compliance with all aspects of QM/SIU processes. Identify and document potentially fraudulent records for further review by SIU Investigators.
AlacrityRichardson, TX
Total Loss Claims Adjuster
09.2021 - 03.2022
Job overview
- Inbound/Outbound calls.
- Review claims coverages.
- Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses.
- Evaluates facts supplied by investigation to determine extent of liability of the insured.
- Evaluate and negotiate settlement of automobile first and third party physical damage claims within established settlement authority limits and negotiates any excessive storage charges.
- Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties.
- Explains procedures and answer inquiries for adjusting auto total loss claims.
- Document the loss, address immediate questions regarding the claims process and reviews and analyzes the vehicle settlement value.
- Provides coordination with internal functions to include appraisal operations, SIU, Counsel, Subrogation and Salvage.
- Refers claims to subrogation as appropriate.
- May arrange for salvage disposition or other recovery. Apply claim handling procedures to process claims, initiate payments, and close claim files.
- Communicate with customers and associates by phone and through other channels.
Veterans Affairs - Sierra 7Austin, TX
Financial Accounts Technician
04.2020 - 08.2021
Job overview
- Primary support to all users on any incident encountered while using any component of VA financial systems.
- Tasks will include answering "how to" questions, verifying transaction information and ensuring application setups are correct.
- Serves as point of contact at the Financial Services Center for commercial vendors, medical providers, caregivers and staff at VA Medical Centers, regional offices, staff offices and cemeteries.
- Responds to inquires related to all facets of the Financial Services Center including but not limited to comprehensive analysis and resolution of problems encountered by the users of financial systems, vendor and provider payments, 1099 reporting, electronic fund transfer (EFT) payment, offsets, tier 1 travel and payroll issues.
- Resolve problems, facilitate resolution with VA facilities when the solution lies elsewhere, expedites payments, or implements necessary corrective measures within established facility policies and mandates.
- Analyzed financial documents and other materials to ensure accuracy of provider information.
- Resolved complex issues related to provider enrollment, including discrepancies between submitted data and existing records.
- Identified potential fraud or abuse cases involving provider enrollments and reported findings accordingly.
CelinkAustin, TX
HUD Claims Specialist IV
06.2019 - 04.2020
Job overview
- Management of claims on all HUD insured assets as assigned, obtaining all necessary information needed to file 27011 claims to HUD for reimbursement, and providing coverage for other processors as necessary.
- Perform daily follow-up of all assigned assets to ensure a smooth process to avoid delays.
- Respond to all incoming requests regarding claims status.
- Conduct proactive and effective pipeline management in accordance with standard performance expectations.
- Update Reverse Mortgage Servicing System (RMSS) with the status of assigned claims including events completed and/or delays.
- Complete proper review and execution of needed supporting documentation to ensure claim can be submitted to HUD properly and timely.
- Verify the accuracy of all relative documents extracted from various resources, including invoices, internal departments, vendors, and external servicers.
- Receive, research and resolve inquiries in a timely and accurate manner and communicate effectively with the vendor, client, investor, internal departments, and external servicers when necessary.
- Ensure compliance with HUD guidelines, company policies, relevant laws and regulations and maintain integrity of financial data and all aspects of the claims process.
- Review claim and supporting documents to ensure correct dates, descriptions, paid amounts, and invoice amounts are documented and make necessary adjustments.
- Review balance history transactions, advances, and external expense sheets to ensure all applicable expenses have been claimed or removed.
- Liaise with other departments within the company in order to understand and resolve differences.
- Identify opportunities for process improvement and efficiencies.
- Perform timely communication regarding discrepancies, issues or other matters with management.
AccentureAustin, TX
Travel and Expense Analyst
04.2018 - 06.2019
Job overview
- Responsible for matching the Employee Expense Report and the Expense Receipts against the claimed/received supporting documentation.
- Validate a perfect Match of the Expenses vs. Total Claimed.
- Identify, Flag, and Report any items that require follow-up: this includes policy violation, mismatch of receipt and claim, and suspicious items for further clarification/research.
- Communicate with employee on back-up required on any items in question; strong tracking of employee remediation next steps, timing, and ownership.
- Understand and apply company travel & expense policy to resolve issues.
- Ability to perform a deep dive on the root cause analysis, the coding and source documentation, including the criteria review of a Receipt validation.
- Assist with audits of expense and receipts, in collaboration with other teams prior to and after payment reimbursement.
- Escalate issues in accordance with escalation policy, notify leadership of serious procedures and policies violations.
- Identify and communicate process improvement opportunities, including automation, process changes, scripts, and FAQ enhancements.
- Assist with fraud or expense audits/investigations.
- Support audit activities for both SOX and external audits
- Develop, present and/or distribute recurring reports on various Travel & Expense operational and compliance metrics.
- Support the disbursements functions, including issues high volume and dollar payments, researching and reconciling payment variances, performing payment related reconciliations, generating forecasts and reporting, etc.
BCforwardAustin, TX
Fraud Risk Analyst
06.2017 - 04.2018
Job overview
- Conducts both routine to complex investigations in diversified operations, suspected internal and external abuse, elder abuse and financial exploitation, and fraud.
- Analyzes data from the banks fraud analytics software to identify suspected fraud, eliminate false positives, and effectively mitigate and prevent current and future fraud losses.
- Identifies fraudulent and/or suspicious activity and performs thorough and comprehensive investigations.
- Formulates and recommends action response to allegations, files crime reports as appropriate, and testifies in court proceedings as appropriate.
- Researched credit and/or debit card transactions and determining if purchases actually occurred.
- Investigate incoming claims for potential fraud and update customers regarding pending claims.
- Investigate disputed credit and/or debit card transactions and take suitable action to resolve those disputes, including processing refunds and/or debits to cardholders or merchants or writing off transactions.
- Prepares reports for direct manager covering investigative details, results, potential and recovered losses, and recommended loss and recovery prevention actions.
- Utilizes information obtained from numerous databases and third-party sources and identifies red flags that prompt further inquiry.
- Adheres to regulatory requirements and compliance training applicable to position.
- Integrity, discretion, and respect for confidential information.
Kelly ServicesAustin, TX
Remote Chat Agent
04.2017 - 09.2017
Job overview
- Deliver excellent customer service while managing multiple chat sessions simultaneously.
- Provide accurate responses to questions regarding operation and maintenance of products.
- Manage customer inquiries by inserting supportive links, such as videos & other website pages, as well as standard text responses.
- Guide customers to appropriate self-help solutions.
- Document and track product bugs, feature requests, and other observations of customer patterns.
- Delivered software solutions consistent with product roadmap, release plan milestones and key performance indicators.
- Advised customers and users regarding required maintenance practices of diverse software systems for OEM warranty requirements and industry best practices.
- Assisted online users via live chat, web conference and phone to resolve issues related to iOS and Windows use and access.
NovitexAustin, TX
Lead Dispatch Agent
04.2016 - 05.2017
Job overview
- Addressing problems and requests by transmitting information or providing solutions.
- Receiving and dispatching orders for products or deliveries Prioritize calls according to urgency and importance.
- Use email, phone, or computer to send crews, vehicles or other field units to appropriate locations.
- Monitor the route and status of field units to coordinate and prioritize their schedule.
- Provide field units with information about orders, obstacles, and requirements.
- Enter data in computer system and maintain logs and records of calls, activities and other information.
K ForceTemple, TX
Credit Balance Specialist
11.2015 - 02.2016
Job overview
- Performs refund and credit analyses audit and reimbursement functions for all Managed Care, Commercial, Medicare, Medicaid, Self-pay and third party payors for all patient accounts.
- Determines if credit balance is an over contractual, late charges applied, overpayment etc. to ensure appropriate actions are taken to resolve.
- Performs Quarterly reviews for Medicare and Medicaid (based on state guidelines) and submits to client for approval, signature and submission.
- Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory Accurately and thoroughly documents the pertinent credit balance review activity performed.
- Communicate issues to management, including payer, system or escalated account issues.
- Handle correspondence received from payers and patients requesting refunds. Respond timely to emails and telephone messages as appropriate.
- Participate and attend meetings, training seminars and in-services to develop job knowledge.
- Analyzed claims activity associated with each individual provider in order to detect any irregularities.
- Performed thorough data analysis on provider demographics to identify trends or discrepancies.
- Maintained up-to-date records of all providers in the system, including contact information and qualifications.
AerotekAustin, TX
Enrollment Processor
08.2015 - 11.2015
Job overview
- Maintain enrollment and membership records within core internal systems related to qualifications for coverage under contracts or agreements and resolve related issues.
- Perform audits and analyses on completed member data load processes and monitor eligibility loads, data updates and all internal/external requests.
- Work with internal and external stakeholders to communicate and resolve membership data issues.
- Provide timely, efficient support for the eligibility load process and coordinate with corporate IS department to resolve issues that arise during the process.
- Review, investigate and resolve inquiries regarding loaded membership.
- Handle and resolve complex member data issues, such as loading errors, limited reconciliations and direct entry of data into core systems.
- Generate adhoc reports on membership across multiple lines of business using Business Objects, Access, and other reporting tools.
Education
Texas A&M University - Central TexasKilleen, TX
Bachelor of Science from Psychology
05.2024
University Overview
Central Texas CollegeKilleen, TX
Associate of Arts from Social Sciences
12.2014
University Overview
Arthur Hill High SchoolSaginaw, MI
High School Diploma
06.2010
University Overview
Skills
- Analytical thinking, planning
- Strong verbal and personal communication skills
- Accuracy and attention to details
- Organization and prioritization skills
- Problem analysis, use of judgment and ability to solve problems efficiently
- Adaptability and ability to work under pressure
- Handling sensitive information
- Positive and professional
Certification
Insurance Adjuster - All Lines
February 2018 to October 2025
Timeline
Claims Analyst
Rose International
12.2022 - Current
Appeals and Grievances Specialist 3
Humana
10.2021 - 07.2023
Total Loss Claims Adjuster
Alacrity
09.2021 - 03.2022
Financial Accounts Technician
Veterans Affairs - Sierra 7
04.2020 - 08.2021
HUD Claims Specialist IV
Celink
06.2019 - 04.2020
Travel and Expense Analyst
Accenture
04.2018 - 06.2019
Fraud Risk Analyst
BCforward
06.2017 - 04.2018
Remote Chat Agent
Kelly Services
04.2017 - 09.2017
Lead Dispatch Agent
Novitex
04.2016 - 05.2017
Credit Balance Specialist
K Force
11.2015 - 02.2016
Enrollment Processor
Aerotek
08.2015 - 11.2015
Texas A&M University - Central Texas
Bachelor of Science from Psychology
Central Texas College
Associate of Arts from Social Sciences
Arthur Hill High School
High School Diploma
Insurance Adjuster - All Lines
February 2018 to October 2025
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