Janae Latson
Stone Mountain
Summary
Grievances & Appeals Specialist with 9+ years experience in healthcare claims management and customer service. Proficient in investigating member and provider concerns through detailed reviews of clinical documentation and benefit policies. Demonstrated ability to build cases, manage denials, appeals, and grievances, while ensuring compliance with HIPAA and regulatory standards. Consistently delivers timely, accurate resolutions, exceeding performance and quality metrics in production-driven environments.
Overview
9
9
years of professional experience
Work History
Claims Examiner II
Delta Dental Insurance Company
10.2023 - 04.2025
- Processed dental insurance claims with a 98% accuracy rate, exceeding established benchmarks.
- Reviewed complex claims to ensure accuracy and adherence to policy guidelines.
- Utilized various software programs for efficient claims processing and record keeping.
- Maintained production goals while ensuring compliance with industry regulations.
- Focused on process improvement initiatives to enhance operational efficiency.
Escalation Complaint Coordinator
Delta Dental Insurance Company
02.2022 - 10.2023
- Resolved complex claims issues, ensuring compliance and effective coordination of solutions.
- Coordinated with cross-functional teams to deliver efficient resolutions, enhancing customer satisfaction.
- Managed inbound calls for updates, issue escalation, and new dispute intake processes.
- Maintained precise documentation of escalated complaints, facilitating thorough follow-ups.
- Streamlined complaint resolution processes for members and providers to improve efficiency.
Dental Assistant | Front Desk Coordinator | Assistant Practice Manager
Windham Dentistry Group
02.2016 - 01.2022
- Managed front office operations, including appointment scheduling and insurance verification, reducing claim delays.
- Optimized patient intake processes, cutting wait times and improving overall satisfaction.
- Collaborated with providers on claim coding accuracy, increasing reimbursement efficiency.
- Trained staff on procedures to enhance teamwork and operational excellence.
- Analyzed patient feedback to identify service gaps, enabling targeted improvements for retention.
- Promoted to Assistant Practice Manager in 2020 due to outstanding performance.
Education
Certified Dental Assistant -
Everest Institute
Norcross, GA01.2016
High School Diploma -
Lithonia High School
Lithonia, GA05-2010
Skills
- Healthcare claims
- Problem solving
- Document review
- Customer focused
- Multi-tasking
- Claims processing and adjudication
- Policy and regulatory compliance
- Appeals and denials management
- HIPAA/Confidentiality compliance
- Microsoft Office
- Microsoft Excel
- Verbal and written communication
- Claims resolution
- Time management
- Analytical thinking
- organized
- Data entry
- Inventory management
- Case building
Timeline
Claims Examiner II
Delta Dental Insurance Company
10.2023 - 04.2025
Escalation Complaint Coordinator
Delta Dental Insurance Company
02.2022 - 10.2023
Dental Assistant | Front Desk Coordinator | Assistant Practice Manager
Windham Dentistry Group
02.2016 - 01.2022
Certified Dental Assistant -
Everest Institute
High School Diploma -
Lithonia High School
Similar Profiles
Andrea DossAndrea Doss
Customer Advocate at Delta Dental Insurance CompanyCustomer Advocate at Delta Dental Insurance Company
Descartes ReneDescartes Rene
Customer Advocate at Delta Dental Insurance CompanyCustomer Advocate at Delta Dental Insurance Company
Ivy ChiangwaIvy Chiangwa
Customer Service Advocate at Delta Dental Insurance CompanyCustomer Service Advocate at Delta Dental Insurance Company
Elizabeth Civil BaptisteElizabeth Civil Baptiste
Staff Nurse II at Northside HospitalStaff Nurse II at Northside Hospital
Sydney BowserSydney Bowser
Server/Lead Server at Always Fresh Neighborhood Market and RestaurantServer/Lead Server at Always Fresh Neighborhood Market and Restaurant