Jacqueline Bell
Jackson,MS
Summary
Business Analyst–level claims expert with 20+ years of experience in claims adjudication, configuration, payment integrity, and regulatory interpretation across Medicaid, Medicare, and commercial lines of business. Proven ability to translate state, CMS, and health plan requirements into accurate business rules, edit logic, and configuration strategies. Skilled in validating rule-based logic, performing advanced root-cause analysis, and partnering with IT, vendors, and cross-functional teams to ensure compliant, optimized claims editing outcomes. Recognized for strong ownership, analytical depth, and the ability to manage complex requirements across multiple states and platforms.
Overview
28
28
years of professional experience
Work History
Claims Liaison II
Centene Corporation
04.2019 - Current
- Role Alignment Highlights:
- Interprets state Medicaid bulletins, CMS guidance, and health plan requirements and translates them into configuration updates, pricing logic, and claims processing rules.
- Owns the lifecycle of claims issue resolution, including requirements intake, configuration review, validation, deployment coordination, and ongoing maintenance.
- Performs advanced root-cause analysis on configuration defects, pricing errors, authorization mismatches, and eligibility discrepancies.
- Partners with IT, vendors, Payment Integrity, and health plans to ensure accurate implementation of system changes and edit logic.
- Leads working sessions and cross-functional meetings to clarify requirements, assign priorities, and maintain traceability from requirement to outcome.
- Key Accomplishments:
- Resolved 100+ provider claims issues per quarter, improving adjudication speed by 30%.
- Identified and corrected 50+ audit discrepancies monthly, reducing denials by 15%.
- Improved provider satisfaction by 25% through timely resolution of authorization and eligibility issues.
- Reduced pended claim pricing errors by 40% by implementing standardized pricing review processes.
- Employee of the Quarter nominee; created team workgroups to improve training and process consistency.
- Key Responsibilities:
- Translate regulatory and business requirements into actionable configuration direction and documentation.
- Review and validate rule-based logic, pricing rules, and configuration outputs for accuracy and completeness.
- Monitor regulatory updates and submit change requests (CRs) to ensure system alignment with coverage and reimbursement requirements.
- Audit check runs, identify discrepancies, and coordinate corrections with claims and IT teams.
- Document, track, and resolve provider claims projects; maintain governance and traceability.
- Analyze trends in claims processing and recommend workflow or configuration improvements.
- Collaborate with cross-functional teams to ensure accurate deployment of system changes.
- Travel for provider engagement and issue resolution.
Senior II Claims Specialist
BlueCross BlueShield of Mississippi
Flowood, MS
08.1998 - 08.2008
- Role Alignment Highlights:
- Conducted root-cause analysis on high-value claim denials and system discrepancies.
- Ensured compliance with regulatory requirements and internal policies.
- Provided audit findings that informed system and policy updates.
- Key Accomplishments:
- Audited 175+ claims daily, recovering $237,000 in the first year.
- Reduced denial rates by 20% through analysis-driven process changes.
- Improved audit efficiency by 30% by mentoring junior auditors.
- Maintained 95%+ quality rating and exceeded production goals.
- Received the Top Five Award for outstanding performance.
- Key Responsibilities:
- Investigated claim denials and discrepancies; collaborated with providers for resolution.
- Maintained detailed audit documentation (HIPAA compliant).
- Processed and validated complex, high-dollar claims (up to $5M).
- Supported team operations and workflow management.
- Identified trends and recommended process improvements.
Claims Specialist I & II
BlueCross BlueShield of Mississippi
01.1999 - 07.2008
- Role Alignment Highlights:
- Conducted detailed claim reviews, reimbursement validation, and appeals analysis aligned with policy and regulatory requirements.
- Performed claims testing following configuration updates and system changes.
- Identified logic gaps, documentation issues, and reimbursement discrepancies requiring system or process updates.
- Key Accomplishments:
- Processed 300+ claims per month with 95% accuracy.
- Reduced processing time by 20% through workflow improvements.
- Maintained 98% customer satisfaction by resolving inquiries promptly.
- Achieved 90% resolution within 30 days for a portfolio of 500+ claims.
- Reduced fraudulent claims by 25% through investigative analysis.
- Improved team efficiency by 15% by developing training materials.
- Performed QA audits that improved overall claim quality.
- Key Responsibilities:
- Reviewed and resolved claims for BCBS, Medicaid, CHIP, and Medicare.
- Investigated provider disputes and appeals; provided detailed findings.
- Conducted claims testing after configuration updates.
- Ensured accurate reimbursement and appealed incorrect payments.
- Submitted corrected claims with supporting documentation.
- Monitored appeal outcomes and ensured accurate posting.
- Coordinated subrogation-related claims and maintained documentation.
Education
BBA -
Delta State University
Cleveland, MS05.1997
Skills
- Regulatory Interpretation (State, CMS, Medicaid)
- Claims Editing & Rule-Based Logic Validation
- Configuration Strategy & Requirements Translation
- Payment Integrity & Reimbursement Logic
- Root-Cause Analysis & Defect Resolution
- Cross-Functional Leadership & Governance
- Claims Adjudication & System Optimization
- SQL (End User)
- ServiceNow
- Amisys
- OMNI
- Webstrat/PSI
- Emptoris
- Microsoft Word
- Excel
- Outlook
- Teams
Timeline
Claims Liaison II
Centene Corporation
04.2019 - Current
Claims Specialist I & II
BlueCross BlueShield of Mississippi
01.1999 - 07.2008
Senior II Claims Specialist
BlueCross BlueShield of Mississippi
08.1998 - 08.2008
BBA -
Delta State University