Shanita Burnside

• Lead and manage a high-performing claims team of 10–15 claims professionals, ensuring consistent achievement of 100% production standards and 98% quality benchmarks.

• Own daily and long-term inventory management while maintaining a 5-day service level agreement (SLA) in a high-volume healthcare claims environment.

• Conduct performance reviews, deliver ongoing coaching, and administer corrective action aligned with business expectations and organizational standards.

• Monitor productivity, quality, and turnaround metrics; analyze performance trends and implement targeted improvement plans.

• Partner with senior leadership to develop, document, and implement Claims Operations Guidelines and Standards.

• Lead multiple process improvement pilots to close operational gaps and improve claim accuracy and efficiency.

• Serve as an escalation point for complex or high-risk claims, applying sound judgment to mitigate exposure and ensure compliant resolution.

• Investigated, evaluated, and resolved healthcare claims with accuracy and compliance.

• Adjusted reserves and provided recommendations aligned with corporate risk standards.

• Audited claims prior to payment authorization.

• Mentored and supported onboarding of new team members.

• Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
• Responded to customer concerns with friendly and knowledgeable service and remedied issues promptly and effectively.
• Contributed to positive team morale by fostering an inclusive work environment that encouraged collaboration amongst colleagues from diverse backgrounds and skill sets.
• Supported customer service and administrative operations.
• Maintained accurate records and documentation.
• Delivered customer-facing support while adhering to privacy standards.

• Led volunteers and staff in structured programming and instruction.
• Developed faith based curriculum focused on behavioral development and accountability.
• Established a culture of continuous improvement by fostering open communication channels and empowering employees to voice their ideas.
• Managed scheduling, engagement, and performance feedback.