Baton Rouge Claim Specialist

Indonesia Wilborn

******************@*****.*** 225-***-**** Baton Rouge, LA

Summary:

Seasoned processing outcomes. professional Seeking and appeals, a role with tracking, as an 7 years appeal and in conducting specialist managed to care, investigations leverage specializing skills. to in insure health accurate claims WORK EXPERIENCE

Blue Cross And Blue Shield Louisiana Remote

Appeal Specialist August 2020 – June 2024

• • Ensure and Perform appeals, adherence. compliance ensuring accurate data thorough with entry company for effective policies tracking, and standards logging, through and processing diligent oversight of documentation and timely updates.

• Collect insightful and reports analyze on data trends on appeals, and disputes, and reconsiderations, providing outcomes to facilitate team awareness and decision-making.

• Prepare and determinations, and organize to comprehensive case files, including necessary documentation streamline the review and reporting of reconsiderations and appeals. Louisiana Department of Insurance

Claim Specialist Feb 2017 - August 2020

• • • Managed Service, Conducted delivering standards. Maintained education and multi-requirements fair comprehensive professional Medical and departmental accurate Management, and competency investigations determinations demonstrating collaboration, to and facilitate growth into in skills including complex compliance integrated by proficiency. fulfilling Claims, grievance case with mandatory Appeals, resolutions. organizational and appeal Customer continuing cases, EDUCATION

Glen Oaks High School-2015

Grambling State University-2019

SKILLS

Appeals • Attention Knowledge Time Management Processing to • Detail Managed • • Data • Verbal Analytical Care Entry Communication • Thinking Claims Processing • Multitasking • Medical • Classification Coding • Organizational • Claims • Medicaid Management Skills •

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