Open to opportunities

LESLIE CHARLESTON

@lesliecharleston

Message

Results-driven analyst with 13 years in healthcare insurance.

United States

Message

What I'm looking for

I am looking for a role that challenges me and allows for professional growth while contributing to impactful projects.

I am a results-driven Claims Analyst with over 13 years of experience in the healthcare insurance industry. My expertise lies in providing meticulous contract data management and translating complex data into meaningful business value. I have a proven track record of resolving intricate claim matters and expounding policy with the utmost attention to quality.

Currently, I am seeking a challenging analyst role within a progressive organization where I can leverage my high-value core competencies and passion for excellence. My recent role at Sagility Health involved generating BI DAX reporting, conducting audits, and utilizing AI tools to reduce inference costs by 35%. I am dedicated to contributing to the synergy and expansion of business goals through my analytical skills and commitment to quality.

Experience

Work history, roles, and key accomplishments

Current

Claims Analyst

Current

Sagility Health

Jul 2022 - Present (3 years)

Generated BI DAX reporting and data extractions, tracked KPIs, isolated trending errors, and performed variance analyses to support strategic decision making. Conducted provider contracting and intelligent automation audits, providing root causation feedback utilizing MS SQL.

Data Analysis Contracts Management Machine Learning Artificial Intelligence SQL Tableau

Research Analyst

UHG United Health Group

Apr 2018 - Jun 2022 (4 years 2 months)

Fulfilled database contract maintenance requests, including updating credentials, tier levels, pricing alignment, and executions. Facilitated simulated AI claims through adjudication application to certify exact implementation, and functioned as a subject-matter expert and technical resource for claims processors.

Data Analysis Contracts Management Claim Adjudication MySQL Tableau Salesforce CareOne

Claims Coordinator

Optum Behavioral Health

Jul 2012 - Mar 2018 (5 years 8 months)

Manually adjudicated behavioral health claims, appeals, and grievances in accordance with CMS guidelines. Analyzed submitted claim data, service charges, EOBs, ICD-9, CPT, and CPT-4 codes, and member eligibility.

Facets Titan CareOne MS Office

Education

Degrees, certifications, and relevant coursework

PRAIRIE VIEW A&M UNIVERSITY

B. A. of Social Sciences, Social Work

Studied social sciences at Prairie View A&M University, focusing on a broad range of topics within the field. Gained foundational knowledge and analytical skills relevant to social structures and human behavior.