Shamika Morris
Duluth,GA
Summary
Medical and insurance claims professional with 3+ years of complex claims adjudication experience within highly regulated healthcare and insurance environments. Proven ability to evaluate medical documentation, interpret policy provisions, manage high-volume caseloads, and make accurate, timely decisions impacting claimant benefits. Recognized for strong analytical judgment, empathetic communication, and consistent adherence to quality, compliance, and turnaround standards. Seeking a Disability Claims Specialist position with MetLife
Overview
9
9
years of professional experience
Work History
Bodily Injury Claims Adjuster
State Farm
Atlanta, GA
05.2022 - Current
- Independently manage a high-volume caseload of 100+ complex claims, ensuring accurate evaluation, documentation, and resolution in accordance with policy provisions and regulatory requirements
- Analyze medical records, treatment plans, functional limitations, and causation to determine liability, exposure, and appropriate claim outcomes
- Serve as escalation point and subject-matter resource, collaborating with legal, medical, and internal partners to resolve complex and litigated claims
Hedis Coordinator
NTT DATA/ CVS Health
Lawrenceville, GA
05.2021 - 05.2022
- Reviewed and analyzed clinical and medical documentation to ensure completeness, accuracy, and compliance with CMS and HEDIS standards.
- Identified documentation gaps and inconsistencies, escalating issues and tracking corrections to completion.
- Collaborated with providers and internal teams to improve documentation quality and audit readiness.
Customer Service Representative III
Kaiser Permanente
Duluth, Georgia
05.2017 - 05.2021
- Reviewed and resolved escalated healthcare cases related to eligibility, benefits, billing, and care coordination, ensuring accurate documentation and adherence to internal procedures.
- Served as subject-matter expert during four open enrollment seasons, supporting quality standards and training new hires.
- Provided peer feedback and coaching to improve documentation accuracy and consistency.
Education
Health Administration
Colorado Technical University
Skills
- Injury Claim Adjudication
- Policy Interpretation & Coverage Analysis
- Risk Assessment & Decision Documentation
- Stakeholder Communication (Claimants, Providers, Employers
- Risk assessment
- Case management
Timeline
Bodily Injury Claims Adjuster
State Farm
05.2022 - Current
Hedis Coordinator
NTT DATA/ CVS Health
05.2021 - 05.2022
Customer Service Representative III
Kaiser Permanente
05.2017 - 05.2021
Health Administration
Colorado Technical University