Shalma Zavala
Select Health
Las Vegas,NV
11
years of professional experience
Detail-oriented healthcare operations professional with 11 years of experience in resolving account discrepancies, interpreting policies, and validating transactions across billing, enrollment, claims, and collections. Expertise includes eligibility analysis, quality review, and payment processing. Committed to translating complex requirements into actionable guidance while ensuring data security and accuracy in high-volume, regulated environments.
Work History
Premium Billing Specialist
7 Months- Analyzed member and employer-group accounts to resolve billing, enrollment, payment, and eligibility discrepancies, ensuring compliance with plan guidelines and established policies.
- Process payments under established financial controls and maintain confidentiality, data privacy, and compliance with applicable state and federal requirements.
- Evaluate reinstatement eligibility, calculate outstanding payment requirements, and document determinations accurately for downstream processing and audit-ready records.
- Review and validate peer-submitted reinstatement requests for completeness, accuracy, and alignment with billing and enrollment standards, strengthening quality assurance before approval.
- Coordinate with employer-group representatives and internal departments to reconcile account adjustments, troubleshoot system or process issues, and move cases through resolution.
- Guided members, agents, and employer contacts through enrollment platforms and documentation requirements, enhancing understanding of account processes via phone, chat, and other communication channels.
- Maintained detailed interaction records while achieving productivity, accuracy, and customer satisfaction performance targets.
Escalation Member Relations Specialist
2 Years 10 Months- Investigated escalated billing, eligibility, provider, and claim issues by researching multiple systems, comparing account details, and identifying effective resolution paths.
- Applied company policies, federal regulations, and health-insurance guidelines to complex member cases while protecting confidential information and maintaining accurate documentation.
- Partnered with internal teams to resolve cross-functional account concerns, clearly communicating findings, next steps, and policy requirements to members and stakeholders.
- Achieved productivity and quality benchmarks in high-volume environment while supporting members through high-stress situations and digital self-service tools.
Claims Representative
2 Years 2 Months- Handled high-volume auto-claims workload, consistently meeting production, quality, documentation, and service standards.
- Conducted structured interviews with insureds, claimants, and witnesses; analyzed claim facts and coordinated resolutions with internal departments based on coverage considerations.
- Ensured complete, accurate, and confidential claim records while effectively balancing customer communication, documentation, research, and follow-up.
Lead Collection Specialist
1 Year 10 Months- Analyzed customer accounts for billing, payment arrangements, credit disputes, collections, and delinquent balances to identify optimal resolution paths.
- Processed payments per financial regulations, generated performance reports, and tracked productivity and quality metrics.
- Explained complex payment options and complex account requirements in clear language to support informed customer decisions.
- Clarified payment options and account requirements in simple terms to enable informed customer decisions.
Assistant Manager
2 Years 5 Months- Managed daily store operations, associate workflow, sales reporting, cash controls, and bank deposits while addressing escalated customer concerns in high-traffic retail environment.
- Trained employees on point-of-sale systems, operating procedures, and service standards to ensure compliance with company policies.
- Led team in achieving sales targets through effective coaching and training initiatives.
- Streamlined inventory management processes to enhance stock accuracy and availability.
- Developed staff schedules to optimize labor costs while maintaining service excellence.
Education
High School Diploma
Skills
Account management
Billing discrepancies
Payment processing
Research documentation
Microsoft Excel
Microsoft Word
Outlook
Teams
Billing systems and software
Insurance verification
CORE QUALIFICATIONS
- Business & Process Analysis
- Healthcare Billing & Enrollment
- Quality Assurance & Validation
- Account Research & Reconciliation
- Cross-Functional Issue Resolution
- Risk & Compliance Awareness
- Process Documentation
- Training & User Support
- Data Accuracy & Recordkeeping
- Reporting & Performance Tracking
- Microsoft Excel, Word, Outlook & Teams
SELECTED ANALYTICAL & LEADERSHIP STRENGTHS
- Quality review: Validate peer work, identify missing or inconsistent information, and confirm alignment with defined billing and enrollment requirements.
- Process improvement mindset: Recognize recurring account issues, clarify handoffs, and collaborate across teams to reduce delays and prevent avoidable rework.
- Technical-to-business communication: Organize complex case information and explain policies, system steps, and resolution requirements to technical and non-technical audiences.
- Training and consultation: Support peers, customers, agents, and external contacts with systems navigation, documentation standards, and procedural guidance.
Timeline
Premium Billing Specialist
Select Health
01.2026 - CurrentRead More
Escalation Member Relations Specialist
Humana
03.2023 - 01.2026Read More
Claims Representative
Kemper Insurance
11.2020 - 01.2023Read More
Lead Collection Specialist
Credit Acceptance
03.2018 - 01.2020Read More
Assistant Manager
ALDO Shoes
10.2015 - 03.2018Read More
Advanced Technologies Academy
High School Diploma
Read More