1. N A K I A L . P A L M E R
731 Blue Sky Drive, Concord, NC 28027 ▪ Phone: (973) 568-6897 ▪ E-mail: nakialpalmer@gmail.com
Insurance Specialist
More than 15 years of health insurance experience including compliance determination and client support.
“I enjoy going beyond the call of duty as a flexible liaison to facilitate collaboration for increased client satisfaction.”
AREAS OF EXPERTISE
 ClientCoordination
 Medical Terminology
 Compliance
 CPT‚ ICD9‚ and HCPCS codes
 Staff Training
 Medical Policies/Benefits
 Meeting Planning
 Provider Relations
 Appeals
 HIPPA
HIGHLIGHTS OF RELEVANT EXPERIENCE
 Organized and facilitated client-facingmeetings and planned agendas resultingin the successful completion of
more than 200 appeals/complaintdecisionsfromthe medical team includingmedical directors.
 Established a systemfor preparing,documenting and routing over 300 cases for clinical reviewleadingto
more timely and efficient information processingand daily management support.
 Facilitated technical trainingresultingin timely education of more than 30 junior claims personnel for an
organization serving3.7 million members.
 Reviewed 2,000 medical policiesand claims regardingclaims-related issues for inpatienthospital,
rehabilitation,and mental health facilities for clarification of utilization management denial issues.
 Evaluated and identified learningmaterials and resources leadingto improvement and greater productivity
for the eight-member medical appeal committee process.
 Responded to and evaluated escalated member/provider appeal and complaintissues resultingin 98%
timely resolution of customer issues.
 Examined policies and procedures and compared againstcurrentregulatory requirements to determine
correct compliancefor more than 1400 cases per week.
 Responded to technical inquiries fromcross-functional teams as a compliancesubject-matter expert.
 Analyzed and monitored 800 benefit reimbursement rates from more than 29 hospitals.
 Researched records and medical information and provided timely 24-hour responsetime to client’s need for
approval prior to surgery by providingsupportfor a complex approval process leadingto positivecustomer
satisfaction.
 Recommended workflow changes for the medical directors resultingin a new communications strategy and
engagement plan for higher levels of team productivity and collaboration.
 Developed an Excel spreadsheet/report documenting all approvalsand denialsfor more than 1200
insuranceclaims cases.
 Resolved issues related to benefit clarification,provider networks, financial transactions,enrollments,and
claims processingwhileassistingwith the processingand payment of 200 claims/week.
 Supervised and trained 15 temporary staff members whileprovidingsupportfor their transition to full-time
status.
CAREER HISTORY
Sr. Appeals Coordinator Horizon Blue Cross Blue Shield of New Jersey 2010-Present
Appeals Coordinator Horizon Blue Cross Blue Shield of New Jersey 2003-2010
Sr. Institutional Provider Services Coordinator Horizon Blue Cross Blue Shield of New Jersey 1999-2003
EDUCATION
MBA, Business Health Care Administration SaintPeter’s University
B.S., Business Management SaintPeter’s University