Shanon Wilson

• Collaborated on a Department of Insurance audit regarding Wellness benefits for a specific Group. This included a review of benefit configuration and claims in two separate systems going back several years; creating tickets for updates; and making necessary adjustments.
• Supported Account Management by creating and presenting Excel spreadsheets to Group Representatives, outlining estimations of claims involved and changes to member benefits and accumulators.
• Enhanced efficiency in resolving configuration issues for benefits and prior authorizations.
• Assisted UAT Testing Team during the annual renewal and new contract testing prior to claims release.
• Assisted IT Configuration Analysts with coding for new benefits.
• I quickly learned to use Claims Test Pro Software, created test suites and cases, created policies for future training.

• Oversaw a team of 9 – 11 Configuration Analysts in the Claims Technical & Analytical Support Team.
• Coordinated training sessions to improve staff skills and overall performance.
• Led team meetings to discuss project updates and address concerns.
• Monitored employee productivity to provide constructive feedback and coaching.
• Developed and presented proposal to Claims Leadership addressing workload concerns.
• Updated ServiceNow ticket catalog requests to capture required information upfront, enabling faster ticket completion.
• Facilitated interdepartmental communication to streamline operations.
• Engaged in leadership forums to foster collaboration and communication among peers, monthly meetings, and training.

• Lead for ASO POD, Dental POD, and Pharmacy teams in project initiatives.
• Collaborated with other POD leads to train team on configuration updates, SQL queries, and address team inquiries.
• Resolved production issues identified by the National and Dental Teams.
• Contributed to multiple projects including Albertsons Consolidation, HEG, and Right Site Right Rx to support organizational goals.
• Led new code update initiatives and co-chaired the relevant workgroup.
• Executed configuration updates for base and supplemental mapping of new codes, creating new queues and roles for HUB changes.
• Retrieved data from Facets (Legacy and Gemstone) using Rapid and MSSQL tools.
• Participated in Member Experience, Preventive Health Workgroup, Prior Authorization Governance, Workflow Subcommittee, and COB TCG.

• Led 11 Claims Examiners on the BlueCard Home Resolution Team.
• Lead Supervisor for the ASO HUB BlueCard Examiners.
• Collaborated with Processing Supervisor on cross-training and inventory management to enhance team capabilities.
• Monitored employee productivity and provided feedback and coaching to foster continuous improvement.
• Conducted performance evaluations to identify growth opportunities and support staff development.
• Facilitated team and department meetings.
• Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions.
• Participated in leadership forums and training sessions to enhance management skills.
• Worked on assigned projects – including Provider email review and Plan to Plan NICE upgrade.

• Created and maintained documentation for health insurance processes, ensuring clarity and adherence to industry standards.
• Reviewed and edited policy documents for compliance, enhanced accuracy and reduced potential risks.
• Performed quality assurance checks on all documentation material before final publication.
• Conducted regular audits of documentation for quality assurance purposes.
• Collaborated with cross-functional teams to gather necessary documentation inputs.
• Developed training materials to support staff in understanding documentation procedures.
• Maintained up-to-date records of all changes made to technical documents.
• Conducted research to verify information in technical documents, supporting the integrity of published materials.
• Managed secure storage, backups, and retrieval of archived documents.

• Handled all aspects of claims processing, review, and outreach for the CMSI Group (Idaho's privately run prison system).
• Processed claims for the National/State of Idaho (SOI) unit; including ASO accounts, Medicare Secondary Reimbursement, and other specialized claims.
• Conducted audits of processed claims to ensure adherence to regulations and standards.
• Communicated effectively with clients regarding claims decisions and inquiries.
• Managed workloads efficiently by prioritizing tasks based on urgency or importance.
• Monitored progress of pending cases through manual follow-up and automated systems to ensure timely resolution.
• Collaborated with internal departments such as underwriting, provider relations, medical management, and quality assurance.
• Developed training plan and documentation for the unit.
• Led UAT testing and developed test cases for several system upgrades and new groups.

• Processed claims using proprietary software, ensuring timely resolution and customer satisfaction.
• Evaluated insurance claims for accuracy and compliance with regulations.
• Communicated claim decisions to policyholders and providers effectively.
• Investigated discrepancies in claims through thorough research, enhancing accuracy and compliance.
• Paid and processed claims within designated authority level.
• Obtained necessary information to complete proper evaluation of injury claims.
• Performed data entry to record information regarding claim status.
• Handled member and provider inquiries in call center regarding Medicare and Medicare Advantage claims, providing clear and accurate information.

I graduated with honors. Teacher’s assistant with computer courses.