# carlotta crayton

carlotta crayton is a remote worker on Himalayas, Retirement Specialist at Empower, based in United States.

Source: https://himalayas.app/@carlottacrayton

```text
Healthcare insurance professional with claims research experience at Anthem and UnitedHealth Group, investigating denials, payment discrepancies, and reconsiderations.
```

| Detail | Value |
| --- | --- |
| Availability | Looking for a job |
| Location | United States |
| Authorized to work in | United States |
| Salary expectations | 47k+ USD |
| Job categories | Claims Research, Insurance Verification Specialist, Claims Processor, Eligibility Specialist, Precertification Specialist, Claims Examiner, QA Specialist |
| Skills | Claims Research, Insurance Eligibility, Benefits Support, Medicare Claims, Medicaid Claims, Reconsiderations, Claims Appeals, Certification Support, Benefits Coordination, Patient Assistance Programs, Root Cause Investigation, HIPAA compliant documentation, 401(k) Plans, 403(b) Plans |

## About

```text
At UnitedHealth Group, I researched claims from initial review through resolution, investigating processing errors and communicating claim status to providers. I managed an average of approximately 110 claims per day.

At BroadPath Solutions, I processed Medicaid claims, researched edits preventing adjudication, and coordinated benefits with Medicare and other carriers. I also referred cases for appeals or medical review.

At Anthem, I reviewed provider requests involving claim payments and denials, researched root causes, and supported remediation of impacted claims. At PAN Foundation, I determined eligibility for disease fund grants and maintained HIPAA-compliant CRM documentation.

Most recently, at EMPOWER, I supported participants with retirement-plan questions and processed disbursement quotes and transactions. My experience also includes claims examination, quality review, and pre-certification and eligibility support.
```

## Experience

### Retirement Specialist

[Empower](https://himalayas.app/companies/empower-com). Aug 2024 - Sep 2026

```text
Supported participants with 401(k), 403(b), and 457 plan questions involving contributions, loans, withdrawals, distributions, and required minimum distributions. Researched complex account questions, explained plan options and requirements, and processed disbursement quotes and transactions accurately.
```

Skills: 401K, 403(B), 457(B), Retirement-Plans, Customer-Support, Disbursements, Research

### Patient Support Specialist IV

PAN Foundation. Aug 2022 - Jul 2023

```text
Supported patients, caregivers, physicians, and pharmacies with enrollment and service needs. Determined eligibility for disease fund grants and explained billing, claims, and patient-assistance requirements.
```

Skills: Patient-Support, Eligibility, CRM, HIPAA, Billing, Claims

### Reconsideration Analyst

Anthem. Dec 2021 - May 2022

```text
Reviewed provider requests involving claim payment outcomes and denials. Researched root causes, collaborated with internal departments, and helped remediate impacted claims.
```

Skills: Claims-Research, Denials, Root-Cause-Analysis, Provider-Support, Documentation

### Inbound Sales Representative

Spectrum. Jul 2021 - Dec 2021

```text
Advised customers on television, internet, voice, and mobile services. Processed service orders, transfers, upgrades, cancellations, and installation appointments while maintaining accurate customer records.
```

Skills: Sales, Customer-Service, Order-Processing, Telecommunications

### Medicaid Claims Processor

BroadPath Solutions. Nov 2019 - Jul 2021

```text
Processed Medicaid claims according to client guidelines and researched edits preventing claims adjudication. Coordinated benefits with Medicare and other carriers and referred cases for appeals or medical review.
```

Skills: Medicaid, Claims-Processing, Benefits-Coordination, Appeals, Research

### Claims Adjustment Specialist

[UnitedHealth Group](https://himalayas.app/companies/unitedhealth-group). Oct 2016 - Jul 2019

```text
Managed an average of approximately 110 claims per day, researching issues from initial review through resolution. Investigated processing errors, coordinated with business partners, documented findings, and communicated claim status to providers.
```

Skills: Claims-Adjustment, Research, Documentation, Provider-communication, High-Volume

## Education

### Superior Real Estate School

Real Estate Certificate, Real Estate. 2021 - 2021

```text
Real Estate Certificate from Superior Real Estate School, completed in 2021.
```

### ECPI University

Bachelor of Science, Healthcare Administration. 2015 - 2017

```text
Bachelor of Science in Healthcare Administration from ECPI University, completed from 2015 to 2017.
```

### Nassau Community College

Associate Degree, Accounting. 1988 - 1991

```text
Associate Degree in Accounting from Nassau Community College, completed from 1988 to 1991.
```

## Tech stack

- OneNote
- Skype
- Citrix
- Microsoft Word

To contact carlotta, message them from this profile with a Himalayas employer account: [Hire on Himalayas](https://himalayas.app/hire).

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