Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Shakina Saunders

Tampa,FL

Summary

Seasoned Disability Insurance Specialist with excellent planning and problem solving abilities. Offering several years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.

Overview

8
8
years of professional experience
1
1
Certification

Work History

Claims Benefit Specialist

Metlife
Tampa, FL
02.2022 - 07.2023
  • Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
  • Collaborated with other departments within the organization to resolve issues related to claims processing.
  • Communicated with other departments to establish action plans and manage open claims to closure.
  • Advised management on potential changes needed in policies or procedures based on findings from investigations.
  • Assisted claimants, providers and clients with problems or questions regarding claims.
  • Precisely calculated refunds, premiums, and adjustments.
  • Investigated medical records and gathered evidence in support of approved or denied claims.
  • Ensured that all decisions were made in accordance with applicable laws, regulations, and policies.
  • Participated in team meetings to discuss case management issues and provide updates on pending disability claims.
  • Reviewed and analyzed disability claims to determine eligibility for benefits.

Claims Benefit Specialist

Aetna, a CVS Health
Tampa, FL
09.2019 - 03.2022
  • Researched medical claims for validity to resolve discrepancies.
  • Accurately processed large volume of medical claims every shift.
  • Processed medical insurance claims to calculate copayments.
  • Assisted customers, claims payers and medical carriers by resolving complex issues.
  • Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
  • Paid and processed claims within designated authority level.

Specialty Pharmacy Representative

CVS Caremark Specialty Pharmacy
Orlando, FL
03.2017 - 09.2019
  • Answered phone calls from physicians' offices regarding medication availability, pricing, and other inquiries.
  • Updated patient profiles by entering new prescriptions and renewals into computer system.
  • Processed third-party payments for prescriptions using appropriate software programs.
  • Provided customer service for patients in the pharmacy, including answering questions about medications.
  • Received payment from customers for prescriptions filled or products purchased.
  • 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.
  • Answered telephones to respond to questions or requests.

Member Service Representative

K-Force Global Solutions Staffing
Orlando, FL
10.2016 - 02.2017
  • Provided support to members regarding account inquiries, processing transactions, and resolving issues.
  • Answered incoming calls regarding membership benefits and services.
  • Greeted customers in a friendly and professional manner.
  • Enhanced member relationships by providing excellent service during each interaction.
  • Handled customer complaints in an efficient and courteous manner.
  • Answered member questions about products and services.
  • Maintained accurate records of member interactions and transactions.
  • Monitored compliance with organizational security protocols when interacting with members.
  • Verified identity information on new accounts using established procedures.
  • Participated in team meetings to discuss customer service strategies and goals.
  • Responded promptly to emails from members seeking assistance.
  • Kept records of customer interactions or transactions, thoroughly recording details of inquiries.

Provider Services Representative

Healthfirst
Lake Mary, FL
02.2015 - 10.2016
  • Verified accuracy of submitted documentation prior to processing claims or services rendered.
  • Followed up with clients on outstanding documents or payments required for processing claims or services rendered.
  • Resolved customer complaints and escalated more complex issues to senior staff members.
  • Adhered to all applicable laws, regulations, standards, and procedures when interacting with customers and providers.

Education

High School Diploma -

Miami Northwestern Senior High School
Miami, FL
06-2002

Skills

  • Benefits Administration
  • Microsoft Office
  • Policy Interpretation
  • Compliance Management
  • Documentation Review
  • Insurance Knowledge
  • Allocating Claims
  • Claims Investigation
  • Verbal Communication
  • Claims Processing
  • Estimate Preparation
  • Teamwork and Collaboration
  • Data Entry
  • Eligibility Determination
  • Insurance Claim Forms Review
  • Customer Service
  • New Policies Processing
  • Liability Management
  • Multitasking
  • Document Control
  • Reporting Skills
  • Insurance Terminology
  • Professionalism
  • Effective Communication
  • Medicaid Knowledge
  • Relationship Building
  • Analytical Skills
  • Analytical Thinking
  • Policy Review
  • 10-Key Touch
  • Account Management Expertise
  • Large-Sum Computations
  • Documentation Abilities
  • Account Management
  • Task Prioritization
  • Records Management
  • Time Management Abilities
  • Self Motivation
  • Reliability
  • Organizing and Prioritizing Work
  • Interpersonal Skills
  • Insurance Coverage Verification
  • Problem-Solving Abilities
  • Active Listening
  • Time Management
  • Understanding of Medical Terms
  • Claim Amount Calculations
  • Decision-Making
  • Attention to Detail
  • Interpersonal Communication
  • Team Collaboration
  • Medical Terminology
  • Organizational Skills
  • Team Building
  • Financial Transactions
  • Background in Insurance
  • Policy Analysis
  • Problem-Solving
  • Regulatory Compliance Adherence
  • Critical Thinking
  • Written Communication
  • Data Integrity

Certification

  • STD/FMLA Training
  • Claims Processing Training

Timeline

Claims Benefit Specialist

Metlife
02.2022 - 07.2023

Claims Benefit Specialist

Aetna, a CVS Health
09.2019 - 03.2022

Specialty Pharmacy Representative

CVS Caremark Specialty Pharmacy
03.2017 - 09.2019

Member Service Representative

K-Force Global Solutions Staffing
10.2016 - 02.2017

Provider Services Representative

Healthfirst
02.2015 - 10.2016

High School Diploma -

Miami Northwestern Senior High School

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Shakina Saunders