Kimberly James

Sr Director Claims & Customer Service at Leading Edge Administrators

Role: Director of Claims at Leading Edge Administrators
Location: Tampa, FL, US
LinkedIn followers: 500 followers

Finance & AccountingView LinkedIn profile

Experience

Director of Claims
Leading Edge Administrators
Apr 2023 — Present · US

Education

St. Petersburg College
Bachelor of Business Administration (BBA), Business Administration, Management and Operations
1989 — 1991

Skills

Workers Compensation
Life Insurance
Subrogation
Customer Service
Ppo
Leadership
Medicare Part D
Health Policy
Claim
Software Documentation
Claim Investigation
Claims Management
Hipaa
Management
Underwriting
Medicaid
Insurance
Healthcare Industry
Property & Casualty Insurance
Disability Insurance
Commercial Insurance
Visio
Process Improvement
Health Insurance
Managed Care
Call Centers
Healthcare
Healthcare Consulting
Claims Handling
Hmo
Provider Relations
Healthcare Management
Network Development
Customer Satisfaction
Claims Resolution
Employee Benefits
Medicare
Long-Term Care

Contact information

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Work email
•••••@leadingedgeadmin.com
Personal email
•••••@•••••.com
Direct dial
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Current company

Leading Edge Administrators

Insurance · 164 employees · Founded 2010 · New York, New York, United States

Leading Edge was formed in April 2010 with the goal of offering a wider array of options to Plan Sponsors responsible for the efficient operation of their plans. To achieve this, we set out to become an independent payer‐advocate with the flexibility to truly act in the best interests of our clients ‐ avoiding the inherent conflicts of carrier‐owned TPAs, or ASO relationships (where the network is the TPA). We have relationships with almost all the major national networks (Aetna, Anthem, Cigna, First Health, Multiplan, etc.) as well as regional networks. This access gives us the ability to select the network which best matches the needs of each client, allowing us to find that “sweet spot” of the right combination of cost containment and participant coverage. Built from the ground up on leading edge proprietary auditing and claims processing technology, our Health Benefits Administration is administered by experts unequaled in the business. To meet our clients’ coverage needs, as well as their bottom line, Leading Edge provides the access, services, and pricing of a large company, while maintaining the intimate, highly responsive level of customer service that is part of our DNA. Our first client was a Taft‐Hartley union benefit fund, with over 300 participating employers and seven plan designs across nearly 3,000 employee lives. Since then, our family of valued clients has grown to almost 100 self‐insured entities, representing tens of thousands of insured lives, in a wide range of businesses from educational institutions, to home furnishing manufacturers, environmental testing companies, home health care agencies, and even a poultry farm.

leadingedgeadmin.com

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Experience

Director of Claims

Education

St. Petersburg College

Skills

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