Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Languages
References
Timeline
Generic

Megan Shaw

Winchester,KY

Summary

Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Outgoing student pursuing flexible part-time employment with weekend and evening shift options.

Overview

12
12
years of professional experience
1
1
Certification

Work History

Claims Processor

Conduent
Lexington, KY
12.2023 - Current
  • Reviewed and verified insurance policy information to assess coverage and determine appropriate claims processing procedures.
  • Managed escalated customer complaints pertaining to denied or delayed payments in a timely manner.
  • Performed quality assurance reviews on completed work to ensure compliance with standards.
  • Identified trends in denials or rejections due to incorrect coding or billing practices by providers.
  • Performed additional duties as requested by management team.
  • Verified claim data correctness in preparation for processing.
  • Reviewed history records to determine benefit eligibility for services.
  • Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
  • Coordinated benefits with medical insurance plans and Medicare providers.
  • Researched medical claims for validity to resolve discrepancies.
  • Conducted and documented comprehensive investigations to negotiate settlements or deny claims.
  • Utilized claims processing software to streamline workflow and increase efficiency.
  • Managed workload to meet or exceed productivity and quality standards.
  • Maintained confidentiality of policyholder information in compliance with HIPAA regulations.

Pharmacy Technician

Genoa Employment Solutions
Greendale, IN
11.2019 - 03.2020
  • Maintained daily inventory of pharmaceuticals and ensured proper storage conditions.
  • Prepared medications for dispensing by counting, pouring, labeling, and verifying doses.
  • Performed data entry for patient profiles, billing information and prescription orders into the pharmacy software system.
  • Managed filing of prescriptions, both electronically and manually.
  • Received payment from customers and processed credit card transactions when necessary.
  • Checked expiration dates on medications to ensure that only unexpired products were dispensed.
  • Restocked shelves with new supplies of medications as needed.
  • Teamed with peers, technicians and pharmacists to prioritize and complete orders.
  • Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems.
  • Refilled medications, offered insight into over-the-counter products and verified insurance benefits.
  • Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.

Pharmacy Technician

Walgreens
Loveland , OH
05.2015 - 11.2019
  • Prepared medications for dispensing by counting, pouring, labeling, and verifying doses.
  • Maintained daily inventory of pharmaceuticals and ensured proper storage conditions.
  • Performed data entry for patient profiles, billing information and prescription orders into the pharmacy software system.
  • Provided customer service to patients by answering questions about medications and health-related topics.
  • Assisted pharmacists in compounding sterile products according to state regulations.
  • Managed filing of prescriptions, both electronically and manually.
  • Retrieved medication from shelves based on physician orders and delivered them to pharmacists for review.
  • Verified accuracy of medication labels before they were dispensed to customers.
  • Ensured compliance with all federal, state, local laws and company policies related to pharmacy operations.
  • Resolved customer complaints in a timely manner while maintaining professionalism at all times.
  • Received payment from customers and processed credit card transactions when necessary.
  • Reported any discrepancies or errors in medication ordering or filling processes immediately to the pharmacist on duty.
  • Checked expiration dates on medications to ensure that only unexpired products were dispensed.
  • Restocked shelves with new supplies of medications as needed.
  • Kept accurate records of controlled substances received and dispensed in accordance with DEA regulations.
  • Organized work areas so that everything was easily accessible when needed.
  • Assisted in training new employees on pharmacy procedures.
  • Teamed with peers, technicians and pharmacists to prioritize and complete orders.
  • Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems.

Lake Attendent

Great Parks of Hamilton County
Loveland , Ohio
01.2014 - 10.2015
  • Cleaned work areas and equipment at the end of each shift.
  • Greeted customers, answered their questions and provided them with assistance.
  • Sold bait in the bait shop
  • Cleaned around the lake
  • Cashier

CSR, Manager

Arbys Resturant
Mason, OH
12.2012 - 05.2015
  • Monitored customer service team's daily activities and provided feedback.
  • Assisted with resolving escalated customer service complaints.
  • Provided guidance on responding to customer inquiries in a timely manner.
  • Trained new employees on departmental processes, protocols, and procedures.
  • Created reports to track customer service metrics such as response time and resolution rate.
  • Evaluated existing processes and recommended changes or improvements where necessary.

Education

High School Diploma -

Goshen High School
Goshen, OH
05-2013

High School Diploma -

Live Oaks CDC
Milford,ohio
05-2013

Some College (No Degree) - Veterinary Science

Uc Raymond Walters
Blue Ash, OH

Skills

  • Claims
  • Allocating claims
  • Claims review
  • Teamwork skills
  • Problem-solving abilities
  • Financial Analysis
  • Computer Proficiency
  • Insurance terminology
  • Professionalism
  • Multitasking
  • Patient contact
  • Background in insurance
  • Denied claims identification
  • Cleaning and sanitizing
  • Veterinary standards and procedures
  • Parasite control
  • Careful restraint
  • Animal Breeding
  • Animal Nutrition
  • Canine health issues
  • Record maintenance
  • Physical Examinations
  • Sterilize instruments
  • Biohazard Disposal
  • Time management abilities
  • Animal Grooming
  • Team building
  • Kennel cleaning
  • Feline cat bag restraint
  • Spay and neuter surgeries
  • Animal Handling
  • Insect control
  • Wound treatment

Accomplishments

  • National technical honors society
  • Parliamentarian for FFA

Certification

  • In high school I took Vet Asst. and earned all certifications needed with the program.

Languages

English
Professional

References

References available upon request.

Timeline

Claims Processor

Conduent
12.2023 - Current

Pharmacy Technician

Genoa Employment Solutions
11.2019 - 03.2020

Pharmacy Technician

Walgreens
05.2015 - 11.2019

Lake Attendent

Great Parks of Hamilton County
01.2014 - 10.2015

CSR, Manager

Arbys Resturant
12.2012 - 05.2015

High School Diploma -

Goshen High School

High School Diploma -

Live Oaks CDC

Some College (No Degree) - Veterinary Science

Uc Raymond Walters

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Megan Shaw