Jocelyn Bradley

Appeals at Angle Health (2025-04 – 2026-07)

Reviewed and processed 15–20 medical appeals daily, ensuring timely and accurate determinations in accordance with company policies and regulatory requirements.
Evaluated clinical documentation, member records, and benefit plans to make informed approval and denial decisions on medical appeals.
Utilized Zendesk to manage appeal cases, document case activity, track communications, and monitor workflow through resolution.
Analyze denied claims, find root causes, and start corrective actions including appeals and resubmissions.
Maintained compliance with HIPAA and internal quality standards while handling confidential member health information.

Claim Specialist at Angle Health (2024-11 – 2025-04)

Processed complex medical claims while ensuring compliance with payer guidelines, benefit plans, and regulatory requirements.
Collaborated with cross-functional teams to improve claim accuracy and reduce processing delays.
Aided in training new team members on claims procedures and best practices.
Resolved escalated claim issues by researching claim history, coverage, and supporting documentation.
Maintain accurate records of claim status, correspondence, and payer responses in the billing system.

Claims Analyst at Angle Health (2023-12 – 2024-11)

Reviewed and analyzed medical claims for accuracy, completeness, and compliance with plan benefits and company policies.
Applied HIPAA guidelines while handling confidential member and provider information.
Consistently met productivity and quality standards in a high-volume claims environment.
Investigated claim discrepancies by reviewing eligibility, coding, and supporting documentation to facilitate accurate claim adjudication.
Prepare, review, and submit claims for diagnostic lab services to commercial and government payers, ensuring compliance with payer guidelines and laboratory policies.

Claim Analyst at United Health Group (2022-10 – 2023-11)

Maintained detailed documentation of claim activity using internal claims management systems while ensuring data accuracy.
Contributed to departmental quality initiatives by identifying trends and helping improve claims processing efficiency.
Identified billing errors, duplicate claims, and payment discrepancies, recommending appropriate claim adjustments when necessary.
Ensured compliance with HIPAA, CMS regulations, and company quality standards when handling protected health information.

Claim Benefit Specialist at CVS Health (2021-03 – 2022-10)

Applied CPT, ICD-10, and HCPCS coding guidelines, along with payer policies, to support correct claims adjudication.
Delivered excellent customer service by providing prompt, correct responses to claims and help inquiries.
Work closely with prior authorization, billing, and reimbursement teams to resolve complex claims and support cross-functional RCM initiatives.
Managed a high-volume workload while consistently meeting productivity, quality, and turnaround time goals.

Benefits Verification Specialist at AmerisourceBergen (2020-11 – 2021-03)

Reporting reimbursement delays or trends to management.
Initiating or documenting prior authorizations, claims appeals, or other reimbursement-related activities when needed.
Communicating with physician offices, pharmacies, insurance representatives, and internal teams to resolve coverage issues.
Stay current with payer requirements, coding updates (CPT, ICD-10), and regulatory changes affecting laboratory claims.

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