SHAKYRA NIANE CRAIG
Dunwoody ,GA
Summary
Claims Specialist well-versed in intricacies of claim management and resolution. Known for strategic approach to resolving disputes and ensuring compliance with industry standards. Reliable team collaborator with focus on achieving optimal outcomes and adapting to changing requirements. Skilled in negotiation and critical thinking.
Overview
14
14
years of professional experience
Work History
Claims Specialist- Auto Injury
State Farm- Hybrid
Dunwoody, GA
01.2024 - Current
- Analyzed claims for accuracy and compliance with policy guidelines.
- Coordinated with clients to gather necessary documentation for claim processing.
- Evaluated loss reports and determined coverage based on policy provisions.
- Resolved complex claims issues by collaborating with underwriters and legal teams.
- Streamlined claims workflow processes, enhancing operational efficiency and reducing turnaround time.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Identified fraudulent claims through diligent investigation and collaboration with law enforcement agencies when necessary.
- Conducted detailed investigations into suspicious claims, successfully identifying and addressing fraudulent activities.
- Coordinated with legal teams on complex claims, ensuring all regulatory requirements were met and protecting company interests.
- Negotiated settlements with claimants and attorneys, achieving favorable outcomes for all parties involved.
Senior Clinical Administrative Coordinator
United Health Group - Optum Health work from home
Atlanta, GA
01.2023 - Current
- Monitored quality assurance program to improve performance and maintain high standards of care.
- Improve policies and procedures through development, implementation, revision and evaluation of new protocols.
- Admitted patients to services and completed thorough clinical documentation.
- Drove attainment of optimal outcomes through case management focused on appropriate treatment, clinical quality assurance and service utilization.
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity.
- Implemented departmental policies and standards in conjunction with management to streamline internal processes.
Phone Triage Nurse
Atlanta Women's health group
Atlanta, GA
10.2020 - 11.2022
- Answered incoming patient calls, gathering history and symptoms to determine scope of medical complaints.
- Rendered telephone advice according to established guidelines and protocols.
- Collected data to represent symptom onset, presenting problem and medical diagnoses.
- Maintained confidentiality in matters related to patient, family and client facility staff.
- Analyzed discussed symptoms with established protocols to determine patient acuity.
- Educated patients relative to health care urgency and community resources available to meet needs.
- Communicated triage information to primary care team to discuss disposition.
- Reviewed medical chart and requested appointments, prescriptions and consultations for urgent needs.
Certified Medical Assistant
Northside Hospital
Woodstock, GA
06.2018 - 01.2020
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate effective treatment.
- Organized charts, documents and supplies to maintain team efficiency.
- Assessed, documented and monitored vital signs for more than [30-50] patients per day.
- Prepared treatment rooms for patients, including cleaning surfaces and restocking supplies.
- Contributed to efficient office operations by triaging patients by severity of medical complaint.
- Educated patients about medications, procedures and physician's instructions.
- Scheduled surgeries by making arrangements with surgical center and verifying times with patients, preparing charts, pre-admission and consent forms.
- Contacted pharmacies to submit and refill patients' prescriptions.
Medical Clinical Coordinator/ Lead Medical Assistant
Atlanta Women's Specialty Group /Harley Anti-Aging Institute
Atlanta, GA
12.2017 - 06.2018
- Managed Daily activities of busy private practice,treating over 50 patients a day.
- Accountable for billing and processing medical claims.
- Coordinated and scheduled surgical appointments and procedures.
- Acted as a Liaison between patients and medical staff; provided administrative support to all medical staff.
- Organized medical records for appointment follow up.
- Responsibilities also included data input of patient demographics verifying,patient insurance coverage,obtaining medical referrals, ordering and maintaining office inventory.
- Maintained all client schedules including communicating with employees,clients,and agency supervisory staff to ensure that schedules are accurate, current, effectively deal with utilization,and are in accordance with plan of care.
- Initiated and completed work assignments in a self-directed manner with minimal need for constant supervision.
- Maintained confidentiality in all professional areas and considers the needs of clients and their families,other employees,physicians,visitors,and all members of the community in an informative ,courteous ,and compassionate manner.
- Consents and practices confidentiality in accordance with the agency HIPPA programs and policies.
Medical Assistant
North Well Health Systems/ Lenox Hill Hospital
New York, NY
08.2016 - 11.2017
- Assisted in obtaining history and vital signs upon patient arrival.
- Provided preliminary reports to physicians and physicians assistants as necessary.
- Responsible for preparing patients for quantitative and qualitative vascular tests including carotid duplex imaging, upper and lower extremity venous studies, venous insufficiency studies, upper and lower arterial studies, and abdominal vascular studies.
- Maintain patient confidentiality by adhering to HIPPA.
- Responsible for patient wound care by applying the use of Unna Boots and disinfectant solutions.
- Assisting physicians and physician assistant with post operative care such as removal surgical sutures and staple removal from incisions.
MEDICAL ASSISTANT
North Well Health Systems, OB-GYN ASSOCIATES
Great Neck, NY
02.2012 - 08.2016
- Responsible for preparing patient rooms prior to their arrival Responsible for collecting urine samples Assisted with transferring residents in and out of wheelchairs and adaptive equipment.
- Kept facility stocked with necessary supplies, equipment and instruments.
- Performed routine tests such as urine dipstick.
- Recognized and reported abnormalities and/or changes in patients' health status to nursing staff.
- Sanitized and cleaned sonogram probes and equipment using Trophon machines and Cydex Solutions.
- Assisted highly reputed physicians in procedures such as Colposcopy, Laminaria insertions, Endometrial Biopsies, and catheter insertions.
- Cleaned, packaged, and sterilized medical instruments Helped physicians examine and treat patients by assisting with instruments, injections and suture removal.
- Made appropriate interventions by reading and interpreting fetal heart monitors.
- Performed pregnancy tests and sent specimens for laboratory testing.
Education
BACHELORS -
ASHFORD UNIVERSITY
2019
Medical Assistant Certificate. -
The New York School for Medical & Dental Assistants
2004
High School Diploma -
East Meadow High School
Meadow, NY2002
Skills
- Managed billing processes to ensure timely and accurate invoicing
- Managed comprehensive documentation processes to ensure accuracy and compliance
- Assisted in imaging processes to support project completion Collaborated with team members to maintain workflow efficiency Contributed to quality control measures for imaging outputs
- Administered injections to patients under supervision Assisted healthcare professionals in maintaining patient comfort during procedures Supported the documentation of patient responses to treatments
- Administered insurance policies and managed client accounts
- Managed inventory levels to ensure optimal stock availability
- Executed laboratory testing procedures to ensure accuracy and reliability of results
- Supported physician in patient care and clinical procedures
- Assisted patients with daily living activities to promote comfort and well-being Supported nursing staff in administering medications and monitoring patient health Collaborated with healthcare teams to ensure quality care delivery
- Conducted comprehensive analysis of pathological specimens to support accurate diagnoses
- Delivered comprehensive patient care by assessing needs and implementing treatment plans
- Facilitated patient preparation for medical procedures and assessments
- Administered comprehensive patient care and treatment plans
- Developed and implemented organizational policies to ensure compliance and operational efficiency
- Executed urine collection procedures to ensure accurate sample acquisition
- Monitored and recorded vital signs to ensure patient health and safety
- Assisted in providing wound care to patients by applying dressings and monitoring healing progress Supported healthcare teams in maintaining a clean and safe environment for wound treatment Collaborated with nursing staff to ensure timely care for patients with wounds
- Ensured adherence to HIPAA regulations to protect patient privacy and confidentiality
- Mastered medical terminology to enhance communication within healthcare teams
- Oversaw inventory and supply management operations to ensure optimal stock levels
- Scheduled patient appointments to optimize clinic workflow and enhance patient satisfaction Assisted patients in navigating scheduling systems to ensure timely access to care Coordinated with healthcare providers to align schedules and minimize appointment conflicts
- Comprehends and interprets complex medical procedures with precision
- Demonstrated exceptional bedside manner to enhance patient comfort and trust
References
References:
References are available upon request.
Additional Information
- Awards: , Awarded Spirit Award 2015 for exceptional Patient Care.
Licensing
Adjuster’s license for FL, NC and SC
Timeline
Claims Specialist- Auto Injury
State Farm- Hybrid
01.2024 - Current
Senior Clinical Administrative Coordinator
United Health Group - Optum Health work from home
01.2023 - Current
Phone Triage Nurse
Atlanta Women's health group
10.2020 - 11.2022
Certified Medical Assistant
Northside Hospital
06.2018 - 01.2020
Medical Clinical Coordinator/ Lead Medical Assistant
Atlanta Women's Specialty Group /Harley Anti-Aging Institute
12.2017 - 06.2018
Medical Assistant
North Well Health Systems/ Lenox Hill Hospital
08.2016 - 11.2017
MEDICAL ASSISTANT
North Well Health Systems, OB-GYN ASSOCIATES
02.2012 - 08.2016
BACHELORS -
ASHFORD UNIVERSITY
Medical Assistant Certificate. -
The New York School for Medical & Dental Assistants
High School Diploma -
East Meadow High School