Shannon Rand
Mercury Insurance
Lithonia,GA
14
years of professional experience
Claims Specialist experienced in investigating discrepancies and resolving disputes across auto, property, and workers' compensation lines. Achieved reduced re-open rates and improved inquiry response times through systematic file audits and efficient tracking tools. Focused on ensuring fair settlements and maintaining compliance with industry regulations while delivering exceptional customer service.
Work History
Claims Specialist
3 Years 10 Months- Audited claim files for missing documentation and reduced re-open rates by implementing a closure checklist.
- Analyzed medical necessity documentation and treatment timelines to determine coverage for workers' compensation claims.
- Coordinated rental car authorizations and extensions for policyholders, ensuring timely support during vehicle repairs after collisions.
- Validated claim amounts by reviewing property damage estimates and repair invoices before issuing payments.
- Coordinated rental car authorizations and extensions for policyholders during vehicle repairs after collisions.
- Processed subrogation recoveries from at-fault carriers, securing reimbursements for paid auto claims.
- Executed tasks remotely
Claims Coordinator
4 Years 3 Months- Flagged suspicious claim patterns by cross-referencing policy terms and submission histories, enhancing fraud detection efforts.
- Built a tracking spreadsheet that reduced claim status inquiry response time from two days to hours.
- Identified and flagged suspicious claim patterns by cross-referencing policy terms and submission histories.
- Detected inconsistencies and incomplete information in claim documentation, facilitating timely escalation to senior staff.
- Validated treatment codes against authorized services and diagnoses in provider invoices and medical records, ensuring compliance and accuracy.
Claims Representative
1 Year 3 Months- Manages an inventory of claims to evaluate compensability/liability.
- Crafted strategic action plan to address case facts and regulatory issues while adhering to established best practices and protocols.
- Oversaw management of litigated claims related to bodily injury and property damage within commercial lines, ensuring effective collaboration with insureds, claimants, attorneys, and other stakeholders throughout litigation and claims-handling processes.
- Executed comprehensive investigations of claims to validate coverage and assess liability, compensability, and damages.
- Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
- Assessed actual damages associated with claims and negotiated settlements within assigned authority limits.
- Fulfilled various tasks as assigned to support team objectives.
Intake Specialist
3 Years 5 Months- Executed data entry for over 40 intake forms daily, ensuring accuracy in medical history and referral documentation.
- Guided patients and families through authorization processes and coverage information to enhance understanding during intake calls.
- Facilitated escalation of urgent cases necessitating same-day clinical review to triage nurses in accordance with behavioral health protocols.
- Validated insurance eligibility and benefits for incoming patient referrals through online portals and direct communication.
- Implemented a centralized tracking spreadsheet that improved coordination and reduced redundancy in intake call processes.
- Mentored and trained four new intake staff on eligibility verification procedures and behavioral health documentation standards.
- Updated the intake form template to capture missing fields, reducing follow-up calls by half.
- Answered patient questions about intake timelines and next steps during initial contact calls.
- Managed remote work environments to support team engagement and project continuity.
- Performed thorough client assessments, focusing on eligibility criteria for service provision.
- Facilitated intake processes by coordinating with healthcare providers and clients.
Education
MBA - Business Administration and Management
Skills
Claims Auditing
Subrogation Recovery
Fraud Detection
Insurance Verification
Policy Interpretation
Documentation Control
Fraud Investigation
Claims Analysis
Process Improvement
Stakeholder Management
Attention to Detail
Critical Thinking
Customer Service
Active Listening
Conflict Resolution
Empathy
Adaptability
Customer support
Time optimization
Listening skills
Goal-driven
Dispute resolution
Product expertise
Data input
Call center operations
Complaint resolution
Chat support
Relationship management
Appointment management
Decision analysis
E-commerce assistance
CRM systems
Zendesk proficiency
Multitasking
Insurance Verification
Communication skills
Timeline
Claims Specialist
Mercury Insurance
10.2022 - CurrentRead More
Claims Representative
Asurion Insurance
01.2019 - 04.2020Read More
Claims Coordinator
Frozen Food Express Trucking
07.2018 - 10.2022Read More
Intake Specialist
Magellan Healthcare
11.2012 - 04.2016Read More
Columbia Southern University
MBA from Business Administration and Management
Read More