Vashon Johnson
Decatur,GA
Summary
Analytical Claims Specialist with proven experience investigating and resolving property, health and business claims. Delivers professional and balanced customer service and meets needs of insured, claimant and internal and external customers. Insurance expert with exceptional knowledge of legal liabilities and claims practices and superior interpersonal skills.
Overview
4
4
years of professional experience
Work History
Claims Specialist
Kasier Permanente (TTEC Contractor)
03.2025 - Current
- Handled all assigned claims promptly and effectively
- Ran all claim reports through company system
- Determined proper policy coverages and applied appropriate claims practices to reach case resolution
- Escalated all claims to necessary departments and reviewed all claims documents for accuracy
- Acted as liaison in reference to all severe incident reports, reinsurance reports and all other case needs
- Built long lasting client relationships and prioritized outstanding customer service
Pre-Authorization Specialist
LabCorp
12.2023 - 02.2025
- Research/review medical policies via Policy Reporter, payer websites, etc
- Contact health plans to verify patient insurance eligibility, benefits, and coverage
- Prepare and deliver patient cost estimates
- Initiate prior authorization with health plans
- Manage correspondence from clients, patients, and health plans
- Clearly and accurately document activities related to prior authorization in prior authorization platform
- Request missing information from patients and/or clients and follow up on requests
- Prioritize workload based on urgency of requests
- Provide status updates from payers on prior authorization requests
Insurance Claims Representative
Flow Health
11.2021 - 11.2023
- Delivered quality customer service to assigned, insured and claimants throughout entire claims lifecycle to promote service times.
- Negotiated settlements for uncomplicated claims in accordance with actual company liability.
- Determined liability, compensability and benefits due on each claim.
- Checked computations of interest accrued, premiums due and settlement surrender on loan values.
- Drafted statements of loss to summarize payments, underlying policy coverages and damages.
Education
High School Diploma -
Redan High School
Stone Mountain05.2013
Skills
- Documentation Review
- Coverage Assessments
- Accident Investigations
- Settlement Determinations
- Data Entry
- Verbal and Written Communication
- Claim Amount Calculations
- New Policies Processing
- Eligibility Determination
- Coverage Determination
- Customer Service
- Microsoft Office
- Data Analysis
- HIPAA compliance
Timeline
Claims Specialist
Kasier Permanente (TTEC Contractor)
03.2025 - Current
Pre-Authorization Specialist
LabCorp
12.2023 - 02.2025
Insurance Claims Representative
Flow Health
11.2021 - 11.2023
High School Diploma -
Redan High School
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