Shanita Banks
Kansas City,MO
Summary
to obtain a position in medical claims where I can utilize my skills and provide world class service while establishing additional communication and claims adjustment skills.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Claims Representative
United Healthcare Group
06.2024 - Current
- Processed claims efficiently, ensuring compliance with company policies and industry regulations.
- Reviewed claim documentation for accuracy, identifying discrepancies and facilitating timely resolutions.
- Communicated effectively with clients to explain claims processes and address concerns promptly.
- Collaborated with cross-functional teams to enhance claims processing procedures and improve client satisfaction.
- Trained new staff on claims processing systems and best practices to promote operational efficiency.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Collaborated with internal departments and external vendors to resolve claims.
- Trained new Claims Representatives on company policies, procedures, and software systems, improving overall team productivity.
Associate Medical claims adjuster
GEHA
08.2022 - 06.2024
- Carefully examining claims to ensure they adhere to all standards, including legal mandates and corporate guidelines.
- Dealing with insurance companies to discuss coverage concerns, claim rejections, or payment amounts.
- Studying medical terminology to comprehend medical diagnosis or processes.
- Interacting with patients and their families on their cases’ claim progress, treatment schedules, and other important topics.
- Keeping thorough records of all claims-related actions, including data on claimants, insurance company personnel, and any parties engaged.
- Examining medical data and bills to ensure accuracy.
- Coordinating with healthcare suppliers and other partners to gather data required for claims processing.
- Check medical claims for the correctness and decide whether insurance policies cover them or if more documentation is needed before reaching a decision.
- Evaluating claims’ eligibility for coverage under the insurance policy’s terms.
Associate Customer service representative
GEHA
01.2019 - 01.2022
- Utilize effective communication, interpersonal and influencing skills to assist and provide complete and accurate information for benefit & claims calls.
- Works independently with periodic supervision to monitor performance
- Responds to inquiries which may include telephone, chat or internet from members and providers concerning verification of coverage, claims and benefits
- Provides information concerning the completion of forms and submission of claims
- Assists customers in locating participating providers in specified areas
- Additionally, provides written lists when requested
- Assist with new Hire Training
Case processor
Us Bank
01.2016 - 01.2019
- Providing high quality customer service by responding to and researching and resolving customer inquiries related to fraud claims.
- Managing a large caseload by researching, investigating, and resolving disputed credit card charges.
- Interacting with customers via written correspondence and telephone to determine the source of the claim and correcting errors.
Customer Service Representative
Us Bank
01.2013 - 01.2016
- Assisting cardholders/bankers with credit card needs
- Using problem solving skills to assist with and solve complex card issues.
- Making reasonable suggestions for promotions that may be an option to cardholders.
- Educating the cardholders on how to best have a long-lasting beneficial relationship with the bank and credit card.
- Being courteous and professional
- Providing world class customer service while following all policies
- Having a knowledge of all products
- Assist with new hire training.
Education
surgical technology
Anthem College
Kansas City, MOcertified nursing assistant program
Penn valley community college
Kansas City, MO12.2007
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Central High School
Kansas City, MO05.2007
Skills
- Microsoft office
- Insurance claims review
- Claims investigation
- Time management
- Team collaboration
- Decision-making
- Interpersonal communication
- Coverage determination
- Documentation review
- Conflict resolution
- Documentation research
- Allocating claims
- Claims processing
- Customer service
- Attention to detail
- Critical thinking
- Teamwork and collaboration
- Eligibility determination
- Documentation processing
- Claims adjustment
Certification
- Certified nursing assistant 2008
- Surgical technology
- CPR certified
Timeline
Claims Representative
United Healthcare Group
06.2024 - Current
Associate Medical claims adjuster
GEHA
08.2022 - 06.2024
Associate Customer service representative
GEHA
01.2019 - 01.2022
Case processor
Us Bank
01.2016 - 01.2019
Customer Service Representative
Us Bank
01.2013 - 01.2016
surgical technology
Anthem College
certified nursing assistant program
Penn valley community college
undefined
Central High School
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