Yolanda Swinney
Griffin
Summary
Detail-oriented and reliable Claims Specialist with 5+ years of hands-on experience reviewing, adjudicating, and resolving healthcare and complex claims in fast-paced, high-volume environments. Known for ensuring regulatory compliance, maintaining data accuracy, and making timely, equitable decisions based on thorough policy analysis. Skilled in collaborating with cross-functional teams, streamlining workflows, and supporting continuous process improvement. Dedicated to delivering efficient claims resolution and a positive experience for members and providers alike.
Overview
12
12
years of professional experience
Work History
Senior Claims Specialist
Internal Revenue Service, IRS
03.2022 - Current
- Ensured all activity was clearly documented in internal systems, maintaining full compliance with audit and operational protocols.
- Facilitated resolution of complex claims to ensure adherence to company policies and regulatory standards.
- Analyzed claims data to identify trends, enhancing decision-making processes and improving operational efficiency.
- Kept up to date with federal and state policy changes through regular compliance training and application in daily workflows.
- Analyzed information gathered by investigation and reported findings and recommendations.
Claims Examiner
Internal Revenue Service, IRS
03.2018 - 03.2022
- Evaluated and processed complex claims for tax refunds, ensuring compliance with IRS regulations.
- Flagged irregular claim patterns and collaborated with fraud investigation units to support recovery efforts.
- Analyzed extensive documentation to identify discrepancies and validate claim accuracy.
- Met or exceeded all productivity and quality goals while maintaining strong attention to detail.
- Conducted audits of processed claims, identifying areas for process improvement and increased compliance rates.
Claims Support Coordinator
Gynecologist Specialist
02.2014 - 02.2018
- Provided operational and administrative support for short-term and long-term claims.
- Managed incoming documents and status inquiries with professionalism and empathy.
- Entered claim data with 100% accuracy, helping maintain clean records and expedite claim resolution.
- Verified turnaround time requirements and prioritized workflows based on plan rules and urgency.
- Maintained internal resources and training materials used by the team to ensure consistency in processes.
Education
High School Diploma -
Maynard Jackson High School
Atlanta, GAMedical Assistant -
Bryman Campus School
Atlanta, GASkills
- Claims Review & Adjudication
- Medicaid, Medicare & Commercial Plans
- Eligibility Verification
- Data Accuracy
- Remote Work Tools
- Healthcare & Disability Claims
- Medical Terminology
- Fraud Detection Support
- SLA & Productivity Management
- Internal Collaboration
- Policy Interpretation
- Regulatory & HIPAA Compliance
- Claims Appeals
- Case Documentation
Personal Information
Timeline
Senior Claims Specialist
Internal Revenue Service, IRS
03.2022 - Current
Claims Examiner
Internal Revenue Service, IRS
03.2018 - 03.2022
Claims Support Coordinator
Gynecologist Specialist
02.2014 - 02.2018
High School Diploma -
Maynard Jackson High School
Medical Assistant -
Bryman Campus School
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