LaTasha Jackson
@latashajackson
Claims Examiner and Operations Specialist specializing in complex healthcare insurance adjudication.
United StatesWhat I'm looking for
I’m an Operations Specialist and Claims Examiner with 15+ years of experience in healthcare and insurance, focused on delivering accurate outcomes in complex claims adjudication. I thrive in fast-paced production environments where attention to detail directly impacts customer experience.
I handle inpatient and outpatient adjudication across Medicaid/Medicare, including adjustments, manual pricing, and coordination of benefits. I review ICD-10, CPT4, HCPCS, and CDT coding and apply medical policy manuals and processing policies to determine correct results.
Across my roles, I’ve worked deeply in core systems—Mainframe (Anthem/WPS), HealthEdge (Delta Dental), CBMS, and C4HCO Platforms—using eligibility research and interactive edits to correct system errors and protect data integrity. I also take responsibility as an escalation point and a primary resource for frontline teams.
I’ve led high-priority projects and supported others through peer coaching, training, and mentoring. My professional ethos is clear: troubleshoot quickly, verify eligibility rigorously, document precisely, and continuously improve claim processing quality.
Experience
Work history, roles, and key accomplishments
Data Entry Operations Specialist II
Hire Connections / Connect for Health Colorado
Sep 2025 - Present (10 months)
Provides high-level troubleshooting and resolution for complex cases, including new applications, change reports, and redeterminations. Acts as a primary resource and escalation point using expert knowledge of CBMS and state Medical Assistance requirements.
Analyzes and adjudicates complex specialty claims, including pharmacy, ambulatory surgery, and durable medical equipment (DME). Reviews ICD-10, CPT4, and HCPCS codes and researches eligibility requirements to correct system errors and interactive edits.
Adjudicates dental claims and pre-treatment estimates to ensure payment within contractual agreements. Uses ICD-9, ICD-10, CPT4, HCPCS, and CDT coding and performs eligibility, Coordination of Benefits (COB), and manual adjustment/pricing work.
Claims Representative III
Anthem Blue Cross Blue Shield
Apr 2008 - Jun 2021 (13 years 2 months)
Analyzes and adjudicates complex specialty claims, including pharmacy, ambulatory surgery, and durable medical equipment (DME). Reviewed ICD-10, CPT4, and HCPCS codes and was selected to coach and mentor new hires and lead special projects.
Education
Degrees, certifications, and relevant coursework
Metropolitan State University of Denver
Bachelor of Science in Computer Information Systems, Computer Information Systems
Completed coursework toward a Bachelor of Science in Computer Information Systems.
Northeastern Junior College
Associate of Applied Science in Pre-Medical Studies, Pre-Medical Studies
Completed coursework toward an Associate of Applied Science in Pre-Medical Studies.
Availability
Location
United StatesAuthorized to work in
Job categories
Skills
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