Rumba
Shaneaquia Kerson
Customer Service
Florence
Summary
Pragmatic Insurance Verification Specialist touting multiple years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
5
5
years of professional experience
Work History
Claims Advocate III
Blue Cross Blue Shield
01.2022 - Current
- Managed a large caseload of claims, ensuring prompt attention to each case and maintaining organized records.
- Developed relationships with key stakeholders, including adjusters and attorneys, to facilitate smoother claim processes.
- Maintained comprehensive knowledge of industry regulations and guidelines, ensuring compliance in all aspects of claim handling.
- Created detailed reports on claim trends and common issues to inform companywide strategies for addressing recurring problems.
- Coordinated with external vendors such as appraisers or repair shops to obtain necessary assessments related to client''s damages or losses quickly and accurately.
Claims Advocate III
Kelly Services
09.2020 - 01.2022
- Assisted clients in understanding policy coverage and benefits, resulting in better-informed decisions about their claims.
- Participated in ongoing professional development opportunities to stay current with industry trends and best practices for claims advocacy.
- Educated clients on loss prevention strategies to minimize future risks and potential claim costs.
- Conducted thorough investigations into complex claims involving multiple parties or extensive damages, ultimately securing fair settlements for clients.
- Collaborated with various departments for efficient claims processing, resulting in quicker resolutions for clients.
- Managed sensitive client information with strict confidentiality, adhering to data protection laws and guidelines at all times.
Patient Care Technician
McLeod Regional Medical Center
05.2019 - 09.2020
- Assisted nurses with essential tasks, streamlining workflow and increasing efficiency in the healthcare setting.
- Assisted in transferring patients, beds and patient care equipment to other rooms adhering to necessary safety precautions.
- Obtained patient vital signs and reported results to staff nurse or physician, noting changes from prior measurements.
- Supported patient admissions, discharges, and transfers to promote team productivity.
- Promoted a safe and inclusive healthcare environment, adhering to policies and procedures while advocating for the well-being of all patients.
- Collaborated with interdisciplinary teams to develop individualized care plans that addressed each patient''s unique needs.
Education
Bachelor of Science in Healthcare Administration - Health Administration
Francis Marion University
Florence, South Carolina12.2020
Skills
Policy understanding
Coverage assessments
Documentation review
Accident investigations
Reporting skills
Insurance coverage verification
Data integrity
Understanding of medical terms
Collaborative relationships
Account management
Planning and Coordination
Activities
Member of Health Occupations Students of America (HOSA) which is an organization that prepares future health professionals for a career in healthcare by hosting meetings to talk about the recent changes in healthcare and numerous opportunities.
Health Occupations Students of America (HOSA)
HOSA is an organization that prepares future health professionals for careers in healthcare by hosting meetings to discuss recent changes in the field and various opportunities available.
Software
IFlow
Microsoft Excel
Timeline
Claims Advocate III
Blue Cross Blue Shield
01.2022 - Current
Claims Advocate III
Kelly Services
09.2020 - 01.2022
Patient Care Technician
McLeod Regional Medical Center
05.2019 - 09.2020
Bachelor of Science in Healthcare Administration - Health Administration
Francis Marion University
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