Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic
Shannon Wainman

Shannon Wainman

Torrington,Connecticut

Summary

Proven Utilization Review Specialist with a track record of excellence at Emblem Health Insurance and ConnectiCare. Elevated to Senior roles for expertise in Utilization Management and Medicare Compliance, demonstrating exceptional decision-making and team collaboration. Skilled in streamlining processes for improved efficiency, embodying reliability with a focus on healthcare regulations.

Programs used: Salesforce, Facets, Epic, Express Scripts and Microsoft Office

Overview

5
5
years of professional experience
1
1
Certification

Work History

Utilization Review Specialist

Emblem Health Insurance
11.2022 - 06.2024

Intake Specialist Utilization Management

Care Specialist UM Intake team- I took a new position with our UM intake prior authorizations department. I input authorizations for the phone and fax requests. I utilize our chat support for assistance and escalations from providers/ Hospitals

11/2023-I was promoted to a Senior Care Specialist position. We assist the care specialists with questions regarding phone and fax inquiries. We also give mentoring sessions, Create and present power point presentations as well as handle all escalations for management.

Concierge Specialist

ConnectiCare
11.2019 - 11.2022

Concierge Specialist - Farmington, Connecticut

Call center advocate for the City of NY Employees in Farmington, CT. We handle all incoming calls pertaining to members health insurance benefits, billing and claim research.


09/2021- I was promoted to a Senior Advocate/ Floor Support for the same team. We assisted the phone team with any support questions. I worked with other delegated entities to assist in resolving complex member issues.

Education

Certificate Program - Health Information And Reimbursement Specialist

Northwestern Connecticut Community College
Winsted, CT
05.2019

Certificate Program - Anatomy Physiology

L&S Coding
Tucson, AZ
02.2019

Skills

  • HIPAA Compliance
  • Quality Improvement
  • Healthcare regulations
  • Medicare Compliance
  • Utilization Management
  • Medical Necessity Criteria
  • Utilization review
  • Reliability
  • Team Collaboration
  • Decision-Making
  • Team building
  • Prior Authorizations

Certification

Health Information and Reimbursement Specialist

Medical terminology, Anatomy and Physiology

Timeline

Utilization Review Specialist

Emblem Health Insurance
11.2022 - 06.2024

Concierge Specialist

ConnectiCare
11.2019 - 11.2022

Certificate Program - Health Information And Reimbursement Specialist

Northwestern Connecticut Community College

Certificate Program - Anatomy Physiology

L&S Coding
Shannon Wainman