QUANKELIA SHOWERS
Tampa,FL
Summary
Experienced healthcare professional with over 7 years of experience in claims processing, benefits verification, and patient support. Skilled in reviewing medical documentation, ensuring compliance with healthcare regulations, and accurately managing high-volume workloads. Known for strong attention to detail, clear communication, and the ability to work collaboratively across teams to support efficient operations and positive patient outcomes.
Overview
11
11
years of professional experience
Work History
Arbitration SpecIalist
Provider Resources
11.2023 - 03.2026
- Analyzed healthcare claims to determine eligibility for arbitration under ERISA, the No Surprises Act (NSA), state and federal regulations
- Reviewed claim discrepancies and identified underpayments to support reimbursement resolution
- Prepared and submitted arbitration cases through required portals, ensuring accuracy and completeness
- Managed high-volume workloads while meeting deadlines and maintaining accuracy
- Communicated updates and findings with leadership regarding case outcomes
- Applied knowledge of medical terminology, CPT coding, and billing practices in claim review
- Tracked claims and trends using Excel to support reporting and workflow
- Drafted clear documentation and summaries to support arbitration case submissions
- Maintained HIPAA compliance and handled confidential information appropriately
- Assisted with process improvements to enhance workflow efficiency
Lead Benefits Verification Specialist
CareMetx
12.2020 - 04.2023
- Monitors seasonal employee task-specific job performance to ensure that specific necessary tasks are completed in accordance with client service level requirements for processing a benefit investigation
- Promoted to team lead for displaying outstanding enthusiasm and remaining calm in extremely trying situations
- Provides coaching and issue resolution support to assigned team members as it relates to the successful completion of a benefit investigation
- Facilitated inter-departmental communication to effectively provide customer support
- Performs related duties as assigned, including benefit verifications.
Prior Authorization Specialist
Gracepoint
10.2018 - 08.2020
- Verified eligibility and compliance with authorization requirements for service providers
- Serve as primary liaison between client, pharmacy, provider, and insurance companies to ensure the most Cost- effective and/or medically necessary medication is used and provided to the client
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel
- Provided outreach for additional information for appeals and grievances.
Customer Service/Authorization Representative
Health Net Federal Services
01.2018 - 09.2018
- Acted as first point of contact for veterans, VA staff members, and physicians for authorizations
- Maintained consistent follow-up on status of prior authorization requests
- Handling claims procedures for clients and guiding them on submitting additional documents
- Tracked referral submission during facilitation of prior authorization issuance and addressed client inquiries and updated database information.
Customer Care Representative
Salem Solutions
06.2017 - 01.2018
- Reviewed and requested medical records, Veterans records and service verification records to determine eligibility status
- Assisted veterans in preparing forms and documents to present claims for benefits
- Provided primary customer support to internal and external customers and answered a constant flow of customer calls with minimal wait times
- Developed community reputation through commitment to customer satisfaction and strong client relationships.
Customer Service Associate/Cashier
Winn Dixie
08.2015 - 02.2016
- Answered questions about store policies and addressed customer concerns
- Helped customers complete purchases, locate items and join reward programs
- Operated cash registers for cash, check and credit card transactions with excellent accuracy levels
- Improved customer satisfaction ratings by addressing issues and fostering timely resolution.
Education
High School Diploma -
Hillsborough High School
Tampa, FLSkills
Customer Service Excellence
Claims processing
Benefits explanation
Relationship building
Detail Oriented
Leadership skill set
Written and oral communication
Documentation and reporting
Medical terminology
Staff coaching and training
Money handling abilities
Claims research
Skills
- Data Entry
- Customer Relations
- Authorizations & Referrals
- Inter-department collaboration
- Team Building
Timeline
Arbitration SpecIalist
Provider Resources
11.2023 - 03.2026
Lead Benefits Verification Specialist
CareMetx
12.2020 - 04.2023
Prior Authorization Specialist
Gracepoint
10.2018 - 08.2020
Customer Service/Authorization Representative
Health Net Federal Services
01.2018 - 09.2018
Customer Care Representative
Salem Solutions
06.2017 - 01.2018
Customer Service Associate/Cashier
Winn Dixie
08.2015 - 02.2016
High School Diploma -
Hillsborough High School