Michael Branham

Experience

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  Firehouse Subs

  Oct 2002 - Aug 2007

  Management

  Assistant ManagerSupervised and helped motivate a team of 15 direct reports. Maintained all paper work up to date and filed. Hired and trained staff. Helped with new product launch and ensured team members understood the new products.• Motivated team members to exceed expectations. • Maintained and organized facility.• Hired and facilitated training for all new team members.• Helped with Rollout of new/promotional products.• Created and managed team members’ schedules.• Responsible for opening and closing the store. • Facilitated monthly safety meetings to ensure compliance was followed.• Managed controllable; food cost, labor control. Show less

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  United States Air Force

  Sept 2007 - Sept 2013

  Security Forces (E-4/SrA)

  • Led, supervised, and trained individual during base operations and security cameras and entry points• Responsible for over 3 million dollars in equipment while deployed as a Tactical Automated Security System (TASS) administrator • Awarded air force and army achievement medal while deployed in Afghanistan for Quick Response Teams, and conveys with Air Force office of Special Investigations (AFOSI)

• 

  Humana

  Oct 2013 - Mar 2016

  Customer Service Representative

  • Receive, document and resolve customer inquiries by using established best practices• Educate customers, providers and employers about Humana’s products over the telephone• Provided claims determination to providers and reported back to leadership.• Handled escalated calls for personnel on my team when management were in meetings.Billing and Enrollment Specialist October 2013 – January 2014• Maintain tracking information and/or process system generated reports for enrollment and/or payment receipts including balancing, reconciling and resolving any data discrepancies or issues• Prepare and/or process enrollment applications and change forms from paper, electronic data, image or phone contact in accordance with established procedures using multiple systems Show less

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  Centene Corporation

  Apr 2016 - Jan 2019

  • Works with and help motivate a team of 23 Claim Examiners tasked with applying policies and provider contract provisions to determine if claims are payable, if additional information is needed, or if claims should be denied. • Travels offsite locally and out of state to meet with provider location to determine claims that can be reprocessed.• Leads Tampa Claims Special Projects team; provide training and support for the team.• Travels offsite on behalf of the company to meet with providers to process claims and reconcile outstanding accounts receivable.• Communicates directly with members of management and other departments to resolve claims issues.• Prepares reports by collecting, analyzing, and summarizing information.• Performs medical claim recoupments, account offsets & claims corrections.• Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter. Show less • Assisted Veterans with scheduling, rescheduling appointments with non-VA providers as required by contractual standards generating over $1M in revenue annually• Worked as a team member; cooperates, assists and collaborates with co-workers to achieve goals and department success, and takes personal responsibility for achieving outstanding quality and results• Performed quality control work; provided feedback and coaching to team members.• Identified, analyzed and resolved a variety of authorization issues selected by management Show less

  • Claims Examiner I (Federal Services)

    Apr 2018 - Jan 2019

  • Authorization and Appointing Representative (Federal Services)

    Apr 2016 - Apr 2018
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  Continental Benefits

  Jan 2019 - Apr 2021

  • Worked escalations coming from clients, brokers, provider, and patients to find resolution; researching issues to assist with retention of business goals.• Reviews audits from representatives, and auto adjudications to fix issues, always looking for potential avoidable errors, & areas we can improve.• Assisting team members with issues, questions, and guidance when times of need, or to step in when leadership needs or unavailable • Resolve medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.• Ensuring coordination of benefits between auto accidents, other accident or commercial insurance claims are done correctly per company guidelines.

  • Team Lead

    Mar 2020 - Apr 2021

  • Sr. claims processor

    Sept 2019 - Mar 2020

  • Claims Processor

    Jan 2019 - Sept 2019
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  Marpai, Inc.

  Apr 2021 - Nov 2022

  Conduct frequent development and training needs analyses; identify and address departmental knowledge deficits.Identify learning objectives; select and deliver instructional methodologies; facilitate learning and development.Customize existing programs; develop new programs and curriculums; meet training needs.Assess trainee performance; evaluate level of understanding and effectiveness of training and development program.

  • Claims Trainer

    Mar 2022 - Nov 2022

  • Claims Team Lead

    Apr 2021 - Mar 2022
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  Ascension

  Feb 2023 - now

  Claims Adjuster