Medical Insurance

Tamicah Jackson

Phone: 904-***-****

E-mail: ***************@*****.***

Areas of Expertise/Skills

Medical Billing & Claim Processing

Windows and Microsoft Office Programs (Word, Outlook & PowerPoint)

Leasing & Rental Management

Professional History

Claims Benefit Specialist, Medicaid Reimbursement, 09/2014 - Present

Aetna

Receive and key claims into claims systems (Mainframe/ACAS/EWMP). Review claims for

accuracy and completeness of information. Apply detailed knowledge of the benefit provision of

the various plans e.g., covered services, co-pays, co-insurance, out of pocket maximums, the

application of claims processing policy and procedure, and use of automated systems.

Review claims that have been identified with pending or hold issues by the automated claims

system, examples include APC pricing errors, Claim Check editing, manual pricing, benefit

limitations, coordination of benefits, duplicate claims, and Medicare supplements. In-depth

knowledge of medical coding and medical terminology. Utilize comprehensive knowledge of

insurance regulations, processes and guidelines to efficiently process medical claims.

Other Party Liability Specialist, Medicare Part D, FEP Provider Relations 09/2011 - 08/2014

Florida Blue

Responsible for notifying Medicare, if other insurance carriers are present for our members.

Responsible for making sure the Health Order of Liability is set correctly for claims processing.

Handled customer complaints pertaining to their health and prescription drug coverage via

telephone. Work monthly and quarterly Medicare reports. Helped other teammates work on new

projects. Resolved claim issues with Providers. Enrolled providers. Make phone calls to other

insurance carriers to verify information. Assist members and employees through their benefits

and open enrollment. Created Blue general inquiries and informational messages to

communicate with other BlueCross BlueShield plans. Provided timely, accurate resolution of

escalated, complex and sensitive customer issues and complaints.

Also proficient in corporate systems such as IMS, RBMS, OCLI, Siebel, MARX, Diamond,

MCG, CMCA, EIP, Legacy, PIP, and, PRIME, Blue2, MSA, NASCO, PAIS, APT,CLAIM

REPOSITORY and ORACLE

Assistant Manager 03/2010-10/2010

Cambridge Management

Responsible for maintaining consistent occupancy rates, showcased properties to prospective

clients, and managed lease and rent collections. Made deposits onto the CMEM payment system.

Developed full knowledge of application information required, screening processes and policies

regarding rentals. Responsible to conduct out-reach marketing at least once per week. Resolved

disputes; including payments and deposit demands, also processed evictions and building

complaints. Created ads and advertised vacant units in prints and social media outlets.

Overviewed addendums for HUD, Section 8, and military agents.

Educational History

Cosmetology License Florida State College Jacksonville, Fl.

High School Diploma First Coast Senior High Jacksonville, Fl.

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