Provider Relations Claims Adjuster

Angela Bradford-Lartey

**** ****** *****, ****** ****, Maryland 20616

Phone: 202-***-**** 240-***-****

Email: ********************@*****.***

Professional Experience

Claims Adjuster Lead/Trainer

Nordstrom, Upper Marlboro, MD

September 2016 - January 2024

Revitalized training methodologies to address employee turnover, enhancing staff development and operational productivity.

Provided mentorship to new hires, significantly improving team competence and work efficiency.

Monitored and reported on staff attendance and progress, aligning team performance with organizational goals.

Grievance and Denial Coordinator/Appeals

Trusted Health Plan, Washington, DC

July 2013 - June 2018

Managed all member appeals, including expedited, pre-service, and external/regulatory cases, with expertise and efficiency.

Conducted thorough investigations and prepared detailed appeals documentation within strict deadlines.

Senior Provider Relations Specialist

Chartered Health Plan, Washington, DC

October 2008 - May 2013

Led initiatives for network development and maintenance, meeting organizational needs effectively.

Organized and conducted orientation and training sessions for new and existing network providers, enhancing provider relations.

Served as the principal contact for resolving issues among provider relations, provider database, and credentialing departments.

Provider Relations Representative

CAREFIRST, INC, Columbia, MD

July 2006 - June 2008

Developed and maintained comprehensive provider networks to support CareFirst members and products.

Successfully negotiated and managed provider contracts, ensuring optimal network performance.

Provider Relations Analyst

CAREFIRST, INC, Columbia, MD

June 1995 - June 2006

Resolved complex provider inquiries, appeals, and correspondence in compliance with legal and regulatory standards.

Ensured consistent and fair resolutions in line with CareFirst policies and contractual obligations.

Claims Adjuster

Government Employees Insurance Co, Washington, DC

January 1989 - January 1994

Addressed complex inquiries from providers and other stakeholders regarding benefits, contracts, and claims, providing detailed and accurate responses. Education

Bachelor of Science in Business Management

University College, University of Maryland College Park, MD Certifications

70-20 Non-Resident Designated Home State - ALL LINES ADJUSTER

XACTIMATE Training

Auto/Property Casualty

Catastrophe Training

Rope & Harness Training

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