SHANEA HARRIS
Freehold,NJ
Summary
Talented Case Manager adept at handling high caseloads without sacrificing quality of care. Operates in high-pressure environments while recommending best resources and courses of action to benefit patient needs and return each to optimal quality of life.
Overview
11
11
years of professional experience
Work History
Medical Case Manager
Plymouth Rock Assurance
Woodbridge, NJ
04.2023 - Current
- Documented case notes daily and coordinated follow-up for seamless case management.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Reviewed provider coding information to report services and verify accuracy.
- Resolved complex, severe exposure claims using high service oriented file handling.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims
- Maintained contact with claimants and attorneys to determine treatment status.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Verified patient insurance coverage and benefits for medical claims.
Auto Claims Adjuster
Plymouth Rock Assurance
Woodbridge, NJ
08.2020 - 04.2023
- Evaluated and investigated over 100 auto claims in a year and decided whether insurer should settle the claim.
- Identified suspicious claims, escalating issues for further investigation and analysis.
- Negotiated with \ claimants to settle claims.
- Carried and managed consistently heavy project workload through exemplary organizational, time management and collaboration talents.
- Successfully negotiated settlements with claimants and insurers.
- Kept current on insurance regulations, laws, policies and procedures.
Licensed Customer Representative
Plymouth Rock
Woodbridge, NJ
07.2017 - 08.2020
- Develop and foster Agent/Company Relationships
- Answer Questions Regarding Policies; Assume Ownership & Follow up on All Contacts
- Develop & Maintain Complete Product Knowledge of All Lines of the Business
- Promoted twice in less than a year
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Liaised with customers, management and sales team to better understand customer needs and recommend appropriate solutions.
Assistant Manager
Enterprise Holdings
Wayne, NJ
12.2012 - 04.2017
- Oversee resolution of customer issues/disputes to ensure satisfactory customer performance ratings
- Increased sales revenue by 75% over 1 year
- Oversee existing & solicit new corporate business to increase company quotas
- Recruit, Interview and Hire New Employees
- Conduct reviews; administer/ recommend disciplinary action, promotions and/or transfers
- Investigate/resolve employee complaints and document employee personnel records
- Mentored sales team in applying effective sales techniques and delivering top-notch customer service.
- Created organization systems for inventory control, merchandising, financial reports and schedules, dramatically increasing operational efficiency.
- Helped with planning schedules and delegating assignments to meet coverage and service demands.
- Assessed job applications and made hiring recommendations to bring in top candidates for key vacancies.
- Conducted weekly staff meetings to motivate staff members, address concerns and questions, plan improvements, and evaluate progress toward goals.
Education
Bachelor of Science - Sports Management, Business Administration
St. John’s University
Queens, NY05.2011
Skills
- Conflict Negotiation
- Report preparation
- Creative problem solving
- Risk Assessment
- Decision Making
- Critical Thinking
- Case Planning and Management
- Team Leadership
- Budgeting and Cost Control
- Employee Training
- Overseeing Employees
Timeline
Medical Case Manager
Plymouth Rock Assurance
04.2023 - Current
Auto Claims Adjuster
Plymouth Rock Assurance
08.2020 - 04.2023
Licensed Customer Representative
Plymouth Rock
07.2017 - 08.2020
Assistant Manager
Enterprise Holdings
12.2012 - 04.2017
Bachelor of Science - Sports Management, Business Administration
St. John’s University
Similar Profiles
KHAGENDRA SIRIPURAPUKHAGENDRA SIRIPURAPU
Solution Architect at Plymouth Rock Assurance Corp.Solution Architect at Plymouth Rock Assurance Corp.
Julia EspositoJulia Esposito
Rental Representative at Plymouth Rock AssuranceRental Representative at Plymouth Rock Assurance
Christopher GrenhamChristopher Grenham
Sales Support Team Leader at Plymouth Rock AssuranceSales Support Team Leader at Plymouth Rock Assurance
Paul MeasleyPaul Measley
Chief Claims Officer Independent Agency Group at Plymouth Rock AssuranceChief Claims Officer Independent Agency Group at Plymouth Rock Assurance
Aiden KaganovichAiden Kaganovich
Digital & Operations Specialist/Warehouse Associate at NY Sign ArtDigital & Operations Specialist/Warehouse Associate at NY Sign Art