Weslee Brooks
Rancho Cordova,CA
Summary
Analytical Claims Specialist with extensive experience in workers’ compensation, health, and pension claims. Currently supporting health insurance members as part of Blue Shield of California by investigating, processing, and resolving complex claims, benefits and eligibility issues. Recognized for delivering professional and balanced customer service, ensuring compliance with regulations, and collaborating across departments to improve workflows and outcomes. Insurance expert with strong knowledge of legal liabilities, claims practices, and exceptional interpersonal skills.
Overview
10
10
years of professional experience
Work History
Designated Correspondence Representative
BLUE SHIELD OF CALIFORNIA
11.2024 - Current
- Investigate, process, and resolve complex health insurance claims in compliance with state and federal regulations.
- Utilize multiple systems and databases to ensure accurate claims, benefits and eligibility information is correctly provided in a timely resolution.
- Collaborate with cross-functional teams to improve claims workflows, reduce errors, and enhance member satisfaction.
- Document all case activity in compliance with company policies and audit requirements.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Managed approximately 30-50 incoming calls, per day from customers.'
Pension Claims Processor
NORTHWEST ADMINISTRATORS
05.2022 - 05.2024
- Reviewed legal documents to determine eligibility based on Department of Labor and Internal Revenue Service law.
- Entered denials and requests for appeal into information system and prepares documentation for further review.
- Collaborated within the claims department to update policies and procedures.
- Organized information by using spreadsheets, databases and word processing applications.
- Worked with employers & Prudential Retirement to resolve any issues or complaints regarding to their monthly benefits.
- Conducted personal interviews via telephone to collect necessary personal information to determine eligibility of retirement status.
- REMOTE
Claims Processor
NTT DATA
03.2020 - 05.2022
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Modified and updated existing policies and claims to reflect change in beneficiary, amount of coverage or type of insurance.
- Exceeded department productivity standards, and reporting requirements.
- Managed workload and priorities to meet claims processing deadlines of 320 claims per week with 97% accuracy.
- Evaluated accuracy and quality of data entered into agency management system.
Workers Compensation Claims Associate
AETNA
05.2015 - 02.2020
- Documented and distributed incoming claim files.
- Determined liability, compensability and benefits due on each claim.
- Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
- Entered appropriate account notes in billing system to clarify actions taken to reconcile claims.
- Examined claims, records and procedures to grant approval of coverage.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Responsible for processing at least 40 cases per week
Education
Bachelor of Arts - Business
WESTERN GOVERNORS’ UNIVERSITY
Remote05-2026
Skills
- Legal document analysis
- Insurance coverage analysis
- Proficient in Microsoft Office
- Detail-oriented data management
- Effective team collaboration
- Medical claims processing
- Clinical utilization review
- Risk coverage assessments
- Dispute resolution assessments
Timeline
Designated Correspondence Representative
BLUE SHIELD OF CALIFORNIA
11.2024 - Current
Pension Claims Processor
NORTHWEST ADMINISTRATORS
05.2022 - 05.2024
Claims Processor
NTT DATA
03.2020 - 05.2022
Workers Compensation Claims Associate
AETNA
05.2015 - 02.2020
Bachelor of Arts - Business
WESTERN GOVERNORS’ UNIVERSITY