Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Shakina Saunders

Tampa,FL

Summary

Experienced Medical and STD/FMLA Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering years of experience and willingness to take on any challenge. Pragmatic Insurance Verification Specialist touting 5 years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail. Experienced 5 years of Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering many years of experience and willingness to take on any challenge. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.

Overview

15
15
years of professional experience

Work History

STD/FMLA Disability Claims Specialist

MetLife
Tampa, FL
02.2022 - 07.2023
  • Manages 50 to 70 STD/FMLA block of claims and companion claims to include Statutory plans, Federal, Company, State and other leave types as required by group customers or Federal, State, Local laws
  • Creates and executes individual claim action plans, serves as point of contact for claimant and provides high-level of service to claimant, including delivering on commitments, timely return phone calls, and clear communication, and makes claim decision
  • Performed other related duties.
  • Generated, posted, and attached information to claim files
  • Maintained confidentiality of patient finances, records, and health statuses
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures
  • Processed and recorded new policies and claims
  • Verified client information by analyzing existing evidence on file

Amazon Delivery Driver

Amazon Flex
Tampa, FL
11.2021 - 06.2023
  • Independent driver delivers Amazon packages while using Amazon flex app with built in GPS to navigate delivery address
  • Delivered packages to customer doorsteps and business offices
  • Maintained upbeat, positive attitude in busy, customer-focused environment
  • Operated vehicle safely in highly congested areas with no traffic violations
  • Completed on-time deliveries by choosing best and most efficient routes
  • Read maps, followed oral, and written instructions and used GPS technology to make deliveries

Claims Benefit Specialist

Aetna
Tampa, FL
09.2019 - 03.2021
  • Process medical claims for payments in Medicare Department
  • Perform other related duties.
  • Conducted full claim investigations and reported updates and legal actions
  • Modified, updated, and processed existing policies
  • Calculated adjustments, premiums, and refunds
  • Processed and recorded new policies and claims

Pharmacy Service Representative

CVS Health/ Specialty Pharmacy
Orlando, FL
03.2017 - 08.2019
  • Answer Inbound calls from customer's calling to refill and schedule delivery of their specialty medication and verify patient Insurance
  • Update Insurance information along with add patient copay assistance information and provide patient with copay amount, schedule medication for delivery with doctor's office
  • Submit claims to patient's Insurance for payment.
  • Coordinated verification and filling of more than 75 daily prescriptions in high-volume call center pharmacy environment
  • Applied mandates of Health Insurance Portability and Accountability Act regulations and company policies complementing or supporting satisfaction of regulatory requirements
  • Set up and modified patient profiles to include current medications and insurance details

Member Service Representative

K Force/Sunshine Health
Orlando, FL
10.2016 - 02.2017
  • Handle incoming calls from Members regarding their health benefits
  • Provide benefit information, Co-pays, deductibles, out of pocket limits
  • Take premium payments, set up autopay for members.

Provider Service Representative

Healthfirst
Orlando, FL
06.2016 - 10.2016
  • Handling incoming calls from Providers, who are checking on Claims status and verifying members benefits eligibility
  • Changing members PCP, updating information.
  • Responded to customer requests, offering excellent support and tailored recommendations to address needs
  • Promptly responded to inquiries and requests from prospective customers
  • Investigated and resolved customer inquiries and complaints quickly

Insurance Verification, Data Entry

Florida Hospital
Orlando, FL
09.2015 - 05.2016
  • Patient Registration/Legal Document Support Responsible for receiving, sorting, filing and or FHL requisition Assist with research and location missing problem requisitions as requested by supervisor and FHL Client services Insurance Verification, data entry, prior authorization Laboratory Clerical Using automatic eligibility process, various payer website and contacting patient for additional information
  • Knowledge of Medicare and Medicaid replacements Send Itemized bills to attorney requesting patient bill charges.

Customer Service/Problem Resolution

Convergys
Orlando, FL
06.2014 - 06.2015
  • Answer inbound calls from AT&T customers regarding their bills
  • Provide rate plan information and or changes
  • Help with troubleshooting apple devices.
  • Recorded details of conversations, complaints and actions taken in CRM
  • Identified and assessed customer's needs quickly and accurately
  • Created and maintained detailed database to develop promotional sales
  • Responded proactively and positively to rapid change
  • Developed and updated databases to handle customer data
  • Responded to customer requests, offering excellent support and tailored recommendations to address needs
  • Managed timely and effective replacement of damaged or missing products
  • Promptly responded to inquiries and requests from prospective customers
  • Investigated and resolved customer inquiries and complaints quickly

Sr. Customer Service Representative

FedEx TechConnect
Fort Lauderdale, FL
08.2012 - 04.2014
  • Answer inbound calls from customer regarding their shipment
  • Resolved complex problems to highest level of customer satisfaction Provide shipping rates, Schedule pick-ups, assist customer with supply orders and Create cases for lost and or damage packages.
  • Resolved customer service issues using company processes and policies and provided updates to customers
  • Engaged clients in person and over phone to answer questions and address complaints
  • Learned and maintained in-depth understanding of product and service information to offer knowledgeable and educated responses to diverse customer questions
  • Processed, scheduled, and executed customer orders for new and established customers
  • Handled customer inquiries and complaints with professionalism to restore satisfaction

Collection Specialist

United Collections Bureau
Miramar, FL
10.2008 - 08.2012
  • Perform outbound calls to collect delinquent accounts, set up payment plans Provide information about accounts unmanageable debt balances, research customer information using third party, skip tracing using Nexis system Educate customer about settlement offers.
  • Used scripted conversation prompts to convey current account information and obtain payments
  • Achieved performance goals on consistent basis
  • Used skip tracing and other techniques to locate debtors
  • Maintained high volume of calls and met demands of busy and productive group
  • Worked in call center environment handling manual and automatically dialed outbound calls
  • Delivered exceptional customer service on collection calls and maintained calm and professional demeanor
  • Collected on delinquent accounts to reduce overdue balances
  • Negotiated payment plans with customers to prevent accounts from entering collections

Education

Diploma - General Studies

Miami Northwestern Senior High School
Miami, FL
01.2002

Skills

  • Customer Relationship Management (CRM)
  • Order Entry
  • Sales Support
  • Order Fulfillment
  • Data Entry
  • Problem Resolution
  • Inventory Management
  • Team Collaboration
  • Customer Service
  • Medical Terminology
  • ICD-10
  • Excel
  • PowerPoint
  • Outlook
  • Word
  • Communications (Oral, Written and Interpersonal skills)
  • Time Management
  • Office Equipment
  • Claim Processing
  • Analysis
  • Disability Claims Process
  • Microsoft Office
  • Corporate Policies and Procedures
  • Customer Relations
  • Customer Inquiries
  • Medical Records Management
  • Service Quality
  • Service Delivery
  • Insurance Industry Experience
  • Account Management Expertise
  • Work Organizing and Prioritizing
  • Regulatory Compliance Adherence
  • Outstanding Clerical Abilities
  • Account Management Software
  • Data Entry Software
  • Claims Preparation
  • Insurance Terminology

Languages

English
Native or Bilingual

Timeline

STD/FMLA Disability Claims Specialist

MetLife
02.2022 - 07.2023

Amazon Delivery Driver

Amazon Flex
11.2021 - 06.2023

Claims Benefit Specialist

Aetna
09.2019 - 03.2021

Pharmacy Service Representative

CVS Health/ Specialty Pharmacy
03.2017 - 08.2019

Member Service Representative

K Force/Sunshine Health
10.2016 - 02.2017

Provider Service Representative

Healthfirst
06.2016 - 10.2016

Insurance Verification, Data Entry

Florida Hospital
09.2015 - 05.2016

Customer Service/Problem Resolution

Convergys
06.2014 - 06.2015

Sr. Customer Service Representative

FedEx TechConnect
08.2012 - 04.2014

Collection Specialist

United Collections Bureau
10.2008 - 08.2012

Diploma - General Studies

Miami Northwestern Senior High School
Shakina Saunders