Lamesha Hudson

Results-driven Quality Assurance Analyst with progressive healthcare insurance expertise across medical claims, pharmacy benefits, enrollment, system testing, and data analysis. Proven ability to identify quality trends, resolve complex processing issues, execute comprehensive test plans, and translate findings into practical process improvements. Recognized for supporting more than 300 self-insured group plans while strengthening accuracy, compliance, and operational efficiency in highly regulated environments.

Medical Benefits Quality Assurance Analyst - BLUE CROSS & BLUE SHIELD OF MISSISSIPPI - FLOWOOD, MS

(2022-11)

• Audit medical claims and enrollment data for accuracy, compliance, and adherence to corporate quality standards.
• Analyze performance data to identify recurring errors, control gaps, and operational trends.
• Prepare quality reports and recommend corrective actions, system enhancements, and procedural improvements.
• Develop and execute test plans for policy, process, and system changes.
• Collaborate with management and training teams to update procedures and instructional materials.

Prescription Benefits Technical Quality Assurance Analyst - BLUE CROSS & BLUE SHIELD OF MISSISSIPPI - FLOWOOD, MS

(2019-08 - 2022-11)

• Validated pharmacy benefit plans, formularies, drug tiers, pricing, and claims configurations.
• Developed and executed quality assurance testing for more than 300 self-insured group plans.
• Performed functional, pricing, and system testing to verify accurate benefit configuration and claims processing.
• Identified, documented, tracked, and retested system defects through resolution.
• Partnered with technical and operational teams to support successful system implementations.

Quality Assurance Analyst - BLUE CROSS & BLUE SHIELD OF MISSISSIPPI - FLOWOOD, MS

(2013-01 - 2019-08)

• Monitored Federal Employee Program, Inter-Plan, and local claims operations for compliance with established standards.
• Compiled and analyzed quality data to identify workflow weaknesses and processing trends.
• Produced performance reports and recommended system, procedural, and operational improvements.
• Supported system testing, implementation activities, and departmental quality initiatives.

Senior Claims Specialist - BLUE CROSS & BLUE SHIELD OF MISSISSIPPI - FLOWOOD, MS

(2005-10 - 2013-01)

• Evaluated complex, high-dollar, and suspended medical claims requiring advanced interpretation of benefits and policies.
• Investigated processing discrepancies and analyzed claims data to identify systemic issues.
• Ensured compliance with federal, state, organizational, and contractual requirements.
• Trained junior claims processors and contributed to internal processing guidelines.

Claims Specialist I and II - BLUE CROSS & BLUE SHIELD OF MISSISSIPPI - FLOWOOD, MS

(1998-07 - 2005-10)

• Reviewed and processed medical claims, adjustments, coordination-of-benefits cases, and overpayment recoveries.
• Investigated eligibility, documentation, payment, and benefit discrepancies.
• Responded to inquiries from members, providers, and participating health plans.
• Consistently met quality, productivity, compliance, and turnaround-time standards.

Bachelor of Arts - Business Administration - Jackson State University