Shaniqua Cobb
Raleigh,NC
Summary
Detail-oriented Claims & Appeals Specialist with 5+ years of experience in healthcare claims processing, Medicare regulations, and complex case resolution. Skilled in analyzing claim data, interpreting policy guidelines, and delivering accurate, compliant determinations. Known for improving claim accuracy, resolving provider and member issues efficiently, and delivering high-quality customer service in fast-paced environments.
Overview
8
8
years of professional experience
Work History
Senior Appeals Coordinator II
Maximus
Remote, NC
01.2025 - Current
- Review and evaluate denied claims and appeals, applying Medicare regulations to make fair, accurate, and compliant determinations
- Analyze complex medical and billing documentation to support evidence-based decisions
- Ensure all case decisions meet regulatory and quality standards while maintaining strict deadlines
- Conduct detailed investigations to resolve discrepancies and uphold claim integrity
- Managed approximately 45 cases, emails and faxes per day from Providers.
Claims Processing Specialist
WPS Health Solutions
Remote
10.2022 - 08.2024
- Processed high-volume medical claims while ensuring accuracy and compliance with insurance guidelines
- Investigated and resolved billing and coding issues for providers and enrollees, improving claim resolution times
- Communicated claim determinations clearly, reducing confusion and repeat inquiries
- Monitored claim status and proactively updated clients, enhancing overall customer satisfaction
- Developed educational content to guide users in correcting rejected or denied claims
- Managed approximately 70 incoming calls per day from Provider.
Health Insurance Agent
HGS (Humana healthcare)
Remote
04.2020 - 06.2022
- Assisted members with Medicare and Medicaid plan selection, enrollment, and coverage questions
- Educated enrollees on benefits, deductibles, and payment responsibilities
- Resolved member concerns efficiently, preventing escalations and improving customer experience
- Analyzed customer needs to recommend appropriate healthcare plans and services
Appointment/Scheduler
Rex UNC Hospital
Raleigh NC
07.2018 - 09.2020
- Answer high-volume inbound customer calls via an automated phone system.
- Utilize resources to troubleshoot and resolve patient issues.
- Provide exceptional customer support with every phone call.
- Review physician schedules and set up doctor’s appointments for patients.
- Coordinated follow-up appointments based on patient needs and physician availability.
- Assisted with pre-registration processes to streamline patient check-in at the hospital.
Education
High School Diploma -
Millbrook High School
Raleigh, NC06-2013
Skills
- Claims Processing & Appeals Review
- Medicare & Insurance Regulations
- Billing & Coding Issue Resolution
- Customer & Provider Communication
- Claims Investigation & Analysis
- Problem-Solving & Decision-Making
- Compliance & Policy Interpretation
- High-Volume Case Management
References
- Destini Cox, Co-worker, (919) 802-6023, Bedestini1234@gmail.com
- Samantha Merde, Manger, (567)-765-2367,Samanthamerde@maximus.com
Timeline
Senior Appeals Coordinator II
Maximus
01.2025 - Current
Claims Processing Specialist
WPS Health Solutions
10.2022 - 08.2024
Health Insurance Agent
HGS (Humana healthcare)
04.2020 - 06.2022
Appointment/Scheduler
Rex UNC Hospital
07.2018 - 09.2020
High School Diploma -
Millbrook High School