Summary
Overview
Work History
Education
Skills
Timeline
Generic

Shamika Wolfe

Euless

Summary

Dynamic Sr. Claims Manager with a proven track record at GBS Enterprises, enhancing claims processing efficiency and driving process improvements. Skilled in effective communication and performance metrics evaluation, I successfully motivated teams to exceed processing goals while maintaining meticulous attention to detail. Committed to delivering exceptional results in claims management.

Overview

20
20
years of professional experience

Work History

Sr. Claims Manager

GBS Enterprises
North Richland Hills
10.2023 - Current
  • Managed claims processing for diverse insurance products at GBS Enterprises.
  • Developed and implemented strategies to enhance claims management efficiency.
  • Collaborated with cross-functional teams to address complex claim issues.
  • Analyzed claim trends to identify areas for process improvement initiatives.
  • Facilitated communication between clients and adjusters to resolve disputes effectively.
  • Motivated team members to maintain targeted turnaround time to obtain processing goals.
  • Conducted meetings to discuss issues and find pertinent solutions to problems.
  • Maintained accurate records of all claim activities in accordance with company guidelines.
  • Evaluated existing processes for managing claims operations in order to identify areas of improvement.

Manager of Service & Claims

Amynta
Fort Worth
12.2011 - 10.2023
  • Managed 26 employees across Service Network and Claims teams to enhance operational efficiency.
  • Contributed to team efforts through process analysis and research, reducing customer escalations.
  • Maintained payments to Servicers and Dealers by issuing ACH, checks, or credit cards.
  • Reviewed and negotiated service center rates and profiles across various systems.
  • Delivered monthly reports to leadership demonstrating improvements from contracted clients.
  • Discussed reconciliations and payment discrepancies with Dealers and Legal teams.
  • Led insurance carrier audits, providing resolutions as necessary.
  • Organized job responsibilities to meet deadlines amid conflicting priorities.

Sr. Claim Processing Audit Recovery Clerk

Sears (Division Office)
Plano
03.2005 - 12.2011
  • Key data completely and accurately into the computer system in a timely manner.
  • Audit claims with the goal of increasing profit for Sears while maintaining a good relationship with Sear's including A&E vendors and business associates.
  • Trained the outsourced team on processing service orders for payment with internet web meetings.
  • Train new employees and assist existing employee's claims questions.
  • Consistently maintained the targeted monthly acceptance rate while exceeding the monthly productivity rate.
  • Research invoices for payment by verifying service performed.
  • Review technical service bulletins and recalls for correct billing purpose to the manufacturer.
  • Identified system problems and recommended solutions for proper billing.
  • Review payment discrepancies according to contracts for underpayment of services rendered.
  • Frequently contacted vendors via phone or email regarding status of incomplete or returned claim issues.
  • Contribute to team effort by applying knowledge to need specifics results.
  • Investigate denied claims for recovery to collect valid payment.
  • Ability to effectively present information in a small group to management and peers.

Education

Diploma - Medical Assisting

Education America
Garland, Tx
09.2002

Diploma -

Longview High School
Longview, Tx
06.1994

Skills

  • Self-motivation
  • Effective communication
  • Claims processing efficiency
  • Service Power proficiency
  • Intermediate computer skills
  • Microsoft Office proficiency
  • Performance metrics evaluation
  • Process improvement focus
  • Claims management
  • Attention to detail

Timeline

Sr. Claims Manager

GBS Enterprises
10.2023 - Current

Manager of Service & Claims

Amynta
12.2011 - 10.2023

Sr. Claim Processing Audit Recovery Clerk

Sears (Division Office)
03.2005 - 12.2011

Diploma - Medical Assisting

Education America

Diploma -

Longview High School

Similar Profiles

CREATE PROFILE