TROY N. SOCOBY
Fort Lauderdale
Summary
Results-driven healthcare claims and reimbursement specialist with proven experience in claims adjudication, audit, and member support within large health plans and hub services. Known for strong analytical thinking, attention to detail, and delivering high-quality service in complex, fast-paced environments. Skilled in reimbursement support, benefit investigations, prior authorizations, appeals, and patient assistance programs. Experience supporting pharmaceutical product launches through workflow design, training support, and operational process improvement.
Overview
6
6
years of professional experience
Work History
Welbe Advocate II
WelbeHealth
04.2026 - Current
- Manage complex scheduling for procedures, diagnostics, and specialty appointments.
- Coordinate appointments across markets, ensuring timely scheduling and service recovery.
- Handle inbound/outbound calls, emails, and chats while resolving participant and provider inquiries.
- Review, process, and authorize orders per department protocols.
- Maintain accurate documentation of appointments, updates, and communications.
- Collaborate with internal teams and external providers to ensure efficient care coordination.
- Troubleshoot scheduling conflicts and escalate issues when necessary.
- Provide eligibility, benefits, and authorization support to participants.
- Ensure compliance with company policies, HIPAA, and quality standards.
- Facilitate patient access through benefit investigations, prior authorizations, appeals, and patient assistance programs.
- Interpret payer policies and coverage criteria to resolve denied or underpaid claims.
- Manage cases end-to-end while coordinating with payers, providers, and internal teams.
- Supported the launch of a pharmaceutical patient assistance program (Axsome Pharmaceuticals).
- Developed job aids and decision-support tools to standardize workflows and improve consistency.
Associate III, Specialty Claims
Florida Blue
07.2024 - 10.2025
- Analyzed complex claims to identify defects and improve processing accuracy.
- Collaborated cross-functionally to resolve escalated claims and ensure proper adjudication.
- Leveraged data insights to support operational efficiency improvements.
- Served as subject matter resource for claim discrepancies and policy interpretation.
Service Advocate III, Claims QIP
Florida Blue / GuideWell
11.2022 - 07.2024
- Reviewed and adjudicated claims in compliance with policies.
- Exceeded quality and productivity metrics in a high-volume environment.
- Investigated complaints and implemented corrective actions.
- Supported peers with claims guidance and escalation resolution.
Member Care Specialist
Florida Blue / GuideWell
09.2021 - 11.2022
- Delivered support for claims, benefits, billing, and enrollment inquiries.
- Guided members through issue resolution and claim explanations.
- Maintained compliant documentation across multiple systems.
- Built strong relationships with providers and internal teams.
Customer Support Specialist
Inktel Contact Center Solutions
Miami
03.2020 - 06.2021
- Delivered tailored customer support and managed warranty claims.
- Responded to inquiries and escalated complex cases appropriately.
- Supported team training initiatives and onboarding efforts.
Education
Master of Science - Healthcare Administration
Rasmussen University
Bachelor of Science - Health Science
University of Southern Maine
Skills
- Reimbursement Support & Hub Services
- Claims Processing & Adjudication
- Benefit Investigations & Prior Authorizations
- Appeals & Denials Management
- Patient Assistance Programs (PAP)
- Eligibility & EDI Troubleshooting
- Claims Research, Audit & Investigation
- Medical Records Review & ICD-10
- Data Analysis & Reporting
- Cross-Functional Collaboration
- HIPAA Compliance
- Customer Service Excellence
- Time Management & Prioritization
- Microsoft Office Suite
Timeline
Welbe Advocate II
WelbeHealth
04.2026 - Current
Associate III, Specialty Claims
Florida Blue
07.2024 - 10.2025
Service Advocate III, Claims QIP
Florida Blue / GuideWell
11.2022 - 07.2024
Member Care Specialist
Florida Blue / GuideWell
09.2021 - 11.2022
Customer Support Specialist
Inktel Contact Center Solutions
03.2020 - 06.2021
Master of Science - Healthcare Administration
Rasmussen University
Bachelor of Science - Health Science
University of Southern Maine