PORCHIA DARBY
Lithonia
Summary
Detail-oriented Claims Analyst with over 5 years of experience reviewing, analyzing, and processing medical claims, appeals, and adjustments. Proven ability to ensure compliance with payer guidelines, resolve complex claim issues, and support timely and accurate claim adjudication.
Overview
10
10
years of professional experience
2
2
years of post-secondary education
Work History
Claims Analyst/Dispute Analyst
COGNIZANT
Wisconsin Rapids
11.2024 - 11.2025
- Reviewed and adjudicated medical claims to ensure accuracy, completeness, and compliance with payer policies.
- Analyzed claim discrepancies, payment variances, and denials to determine appropriate resolution.
- Processed claim adjustments, corrections, and reprocessing requests within established turnaround times.
- Maintained detailed claim documentation and audit-ready records to support quality assurance.
- Conducted audits of processed claims for quality assurance purposes.
Grievance Appeals & Claims Specialist
CVS/AETNA
Decatur
10.2021 - 11.2024
- Reviewed and processed medical claims and appeals to ensure accurate adjudication and timely payment.
- Evaluated CMS-1500 claim forms and EOBs to resolve auto-adjudication and payment issues.
- Identified claim errors related to coding, eligibility, and benefits, implementing corrective actions.
- Collaborated with internal teams to resolve complex claims and prevent processing delays.
Claim Specialist
WPS HEALTH SOLUTION
Decatur
03.2016 - 10.2021
- Analyzed medical claims for coverage determination, benefit application, and payment accuracy.
- Resolved complex claims involving COB, appeals, denials, and payment discrepancies.
- Utilized Facets and Mainframe systems to research, process, and follow up on pending claims.
- Ensured compliance with regulatory requirements and internal claims processing standards.
Education
Bachelor of Science - Human Resources Management
Strayer University
Decatur, GA 02.2024 - 02.2026
Skills
- Medical Claims Processing
- Claims Analysis
- Facets
- Mainframe Systems
- EOB Review
- Epic system
- Dental Grievances and appeals
- CMS-1500 Forms
- Claims Adjustments
- Payment Accuracy
- Regulatory Compliance
- Data Entry
- Medical Coding
- Medical Terminology
- Insurance Verification
- CRM & Salesforce
Timeline
Claims Analyst/Dispute Analyst
COGNIZANT
11.2024 - 11.2025
Bachelor of Science - Human Resources Management
Strayer University
02.2024 - 02.2026
Grievance Appeals & Claims Specialist
CVS/AETNA
10.2021 - 11.2024
Claim Specialist
WPS HEALTH SOLUTION
03.2016 - 10.2021