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Nykevia Owens

@nykeviaowens

Medical claims processor at Tranzact, reviewing claims and building Excel reports to track inventory, aging, and production.

United States

Message

At Tranzact, I reviewed and entered health insurance claims, resolved pended and rejected claims, and checked for coordination of benefits, duplicate billing, and eligibility issues. I also built simple Excel reports to help leads monitor claim inventory, aging, and production.

At Mercalis, I processed medical claims and checked CMS-1500 and UB-04 forms, coding, pricing, and prior authorizations. At spectrum, I adjudicated claims under benefit plans and CMS guidelines, assessed medical necessity, and prepared denial letters and appeals decisions.

Experience

Work history, roles, and key accomplishments

Health Insurance Claims Specialist

Tranzact

Jan 2024 - Oct 2026 (2 years 9 months)

Performed front-end claims review and data entry, validating information for reimbursement. Researched and resolved pended, rejected, and adjusted claims, and used Excel to track claim inventory and production metrics.

Claims Processing Data Entry Excel V Lookups Pivot Tables Coordination Of Benefits Claims Research Communication Skills Remote Collaboration

Medical Claims Processor

Mercalis

Jun 2022 - Jul 2024 (2 years 1 month)

Processed a high volume of medical claims for a health insurance payer with consistent accuracy and timeliness. Reviewed CMS-1500 and UB-04 forms, verified coding, and navigated multiple claims platforms to ensure correct authorization and pricing.

Medical Claims Processing Claims Adjudication CMS 1500 UB 04 ICD 10 CPT HCPCS Prior Authorizations Claims Pricing Data entry accuracy HIPAA compliance Multi system Navigation High Volume

Claims Examiner

Spectrum

Aug 2021 - Sep 2022 (1 year 1 month)

Adjudicated medical claims by applying member benefits according to plan documents, CMS guidelines, and state mandates. Reviewed medical documentation for medical necessity, issued denial letters, and applied grievance and appeals procedures.