Tearah Jones

Analytical and detail-oriented insurance professional with over 10 years of experience in claims, customer service, and healthcare administration. Skilled in investigating and resolving member and provider concerns by reviewing clinical documentation, building accurate case files, and ensuring compliance with regulatory and organizational standards. Strong background in medical claims processing, appeals, and grievance resolution with proven ability to manage case inventory in production-driven environments. Recognized for accuracy, confidentiality, and timely resolution of cases while maintaining member advocacy and positive provider relationships. Proficient in Facets, Microsoft Word, Excel, and healthcare systems with expertise in data entry, documentation, and electronic inventory management.