April Sheared
Philadelphia,PA
Summary
Dynamic professional with a proven track record at Independence Blue Cross, adept in claims processing and regulatory compliance. Excelled in cross-functional collaboration and data-driven decision-making, enhancing operational efficiency by over 30%. Skilled in Adobe Creative Studio and communication, consistently achieving high customer satisfaction and significant annual recoveries.
Overview
14
14
years of professional experience
Work History
Claims Appeals Specialist
Independence Blue Cross
Philadelphia, PA
01.2023 - 01.2024
- Investigates member/provider appeal requests
- Documents investigative steps and outcomes
- Conducts investigations per CMS and regulatory guidelines
- Reviews and updates appeal case documentation
- Resolves appeals per member benefits and policies
- Ensures thorough documentation supports appeal outcomes
- Monitors caseload for compliance timeframes
- Performs additional assigned duties as needed
Community Engagement Research Coordinator
University of Pennsylvania
Philadelphia, PA
01.2022 - 01.2023
- Coordinated 'IGNITE' study on environmental/economic health interventions
- Organized community health outreach initiatives for education and resources
- Assessed environmental/economic intervention impacts in Philadelphia neighborhoods
- Collaborated with UHL for community-informed study design
- Conducted door-to-door recruitment for study enrollment
- Administered health surveys to participants
- Maintained data accuracy in study databases
- Prepared reports via written, verbal, and presentation formats
- Increased program participation through community engagement initiatives
- Established partnerships for new outreach projects with local organizations
- Managed data collection/analysis for community surveys, enhancing programs
- Organized educational workshops for community members on resources
- Secured funding for projects, increasing outreach budget significantly
PIP Claims Examiner
GOVERNMENT EMPLOYEES’ INSURANCE COMPANY
Marlton, NJ
02.2021 - 01.2022
- Researched medical necessity and established causality
- Consulted parties for confidential medical information in claims
- Reviewed reports and billing for customers and stakeholders
- Investigated medical claims for fraud instances
- Evaluated personal injury insurance claims and monitored files
- Streamlined PIP claims process, reducing turnaround time
- Achieved high accuracy in resolving complex PIP claims
- Collaborated with teams, reducing disputes in claims processing
- Implemented training for junior examiners to enhance efficiency
- Documented claims investigations, leading to significant annual recoveries
Licensed Claims Adjuster
GOVERNMENT EMPLOYEES’ INSURANCE COMPANY
BUFFALO, NY
01.2019 - 01.2022
- Investigated vehicular accident reports across North America
- Interviewed witnesses to understand claims and incidents
- Evaluated police reports and video evidence for incidents
- Documented detailed reports on claims and damage
- Researched repair costs for reported vehicle and property damage
- Reviewed insurance policies for coverage determination
- Coordinated with professionals for damage repairs
- Negotiated settlements with claimants and legal teams
- Managed and resolved claims, increasing customer satisfaction
- Trained new adjusters, improving team efficiency and performance
Hospice Aide Coordinator
University of Pennsylvania
Philadelphia, PA
06.2010 - 01.2016
- Supported field staff by triaging patient calls with symptoms
- Communicated medication and scheduling information to staff and families
- Coordinated health and safety programs for workplace procedures
- Organized schedules for a team of home hospice aides
- Developed training programs for hospice aides, improving care quality
- Streamlined scheduling, increasing aide efficiency and patient satisfaction
- Assessed aide performance, reducing patient complaints and enhancing service
- Collaborated on individualized care plans for patients’ needs
- Initiated feedback systems, increasing caregiver engagement and family relationships
- Facilitated improved emotional well-being for patients and families
Education
Master of Advanced Study - African Studies
University of Illinois at Chicago
Chicago, IL06.2021
Bachelor of Applied Science - Speech Language Hearing Science
Temple University
Philadelphia, PA10.2020
Associate of Arts - Communications
Delaware County Community College
Media, PA01.2018
Skills
- Project Management
- Cross-Functional Collaboration
- Data Analysis
- Data-Driven Decision-Making
- Graphic Design
- Adobe Creative Studio
- Claims Processing
- Regulatory Compliance
- Communication Skills
- Customer Support
Additional Information
Crisis Counselor at The Trevor Project, Volunteer Assistant at The Daily Bread Soup Kitchen, Writing Mentor with Mighty Writers
Languages
- English
- Arabic
- ASL
- Wolof: Fluent
Timeline
Claims Appeals Specialist
Independence Blue Cross
01.2023 - 01.2024
Community Engagement Research Coordinator
University of Pennsylvania
01.2022 - 01.2023
PIP Claims Examiner
GOVERNMENT EMPLOYEES’ INSURANCE COMPANY
02.2021 - 01.2022
Licensed Claims Adjuster
GOVERNMENT EMPLOYEES’ INSURANCE COMPANY
01.2019 - 01.2022
Hospice Aide Coordinator
University of Pennsylvania
06.2010 - 01.2016
Master of Advanced Study - African Studies
University of Illinois at Chicago
Bachelor of Applied Science - Speech Language Hearing Science
Temple University
Associate of Arts - Communications
Delaware County Community College