Lavelle Charles
@lavellecharles
Healthcare operations and claims specialist improving fraud-risk quality and productivity in remote environments.
United StatesWhat I'm looking for
I’m a healthcare operations, claims, and fraud/risk professional with 10+ years of experience supporting healthcare, insurance, technology, and customer operations—often in remote environments. I consistently maintain 98–100% quality performance while exceeding productivity goals and managing high-volume case workloads with HIPAA-compliant documentation.
In my roles, I’ve supported claims and provider/member operations, handled escalations, and resolved complex operational issues by monitoring compliance, reviewing fraud-related workflows, and escalating high-risk activity appropriately. I’m especially proud of achieving productivity levels 2x–4x above benchmarks and participating in calibration and process-improvement initiatives to improve consistency, accuracy, and audit readiness.
Experience
Work history, roles, and key accomplishments
Processed and resolved high-volume operational cases while maintaining quality and HIPAA-aligned documentation standards. Exceeded productivity benchmarks (up to 85 cases/hour vs. 20 target) and maintained 98–100% QA scores, while reviewing fraud-related workflows and escalating high-risk activity.
Active Duty Service Member
Army National Guard
Mar 2022 - Present (4 years 3 months)
Served as an active duty service member by applying disciplined time management, communication, and problem-solving in fast-paced operational environments. Supported mission execution through coordination, adaptability, and attention to detail.
Supported healthcare claims and billing inquiries, including pharmacy benefits, while resolving operational issues through compliant case documentation. Coordinated with providers and internal teams to resolve complex cases and maintained audit-ready records with consistent quality and resolution accuracy.
Insurance Operations Specialist
AAA
Jan 2022 - Jan 2024 (2 years)
Handled insurance servicing operations, billing support, and claims-related workflows across multiple systems. Researched and resolved policy/account issues while maintaining documentation accuracy and meeting productivity and quality objectives.
Education
Degrees, certifications, and relevant coursework
Lavelle hasn't added their education
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Availability
Location
United StatesAuthorized to work in
Job categories
Skills
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