Shanta Young
Houston,TX
Summary
Analytical Claims Specialist with proven experience investigating and resolving property, health and business claims. Delivers professional and balanced customer service and meets needs of insured, claimant, internal and external customers. Insurance expert with exceptional knowledge of legal liabilities and claims practices and superior interpersonal skills.
Overview
12
12
years of professional experience
Work History
Claims Denial Litigation Specialist
Sullins Johnston Law Firm
Houston, TX
01.2023 - Current
- Communicated pertinent information to clients via phone, email and mail
- Work closely with management to gather evidence to be used in a trial
- Managed document production process from initial request through completion.
- Developed detailed litigation strategies for over 300 cases.
- Rendered technical and analytical assistance to support attorney litigation needs.
- Aided senior leadership during executive decision-making process, meeting with clients to research cases, collect data, prepare settlement packages and interpret information for daily report generation.
- Analyzed incoming data from sources and provided detailed reports to case teams.
Records Research Specialist
Applicant Insight
Houston, TX
05.2022 - 04.2023
- Investigate Workers Compensation data; Initiates appropriate notices as needed; monitors claimant's case history, noting any prior workers' compensation claims filed
- Collected payments, processed receipts and informed policyholders of outstanding balances.
- Managed and resolved incidents according to service agreements.
- Facilitated productive clinical and technical customer relationships through intentional external communications.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Maintained a database of all current workers' compensation cases.
- Provided customer service to claimants, employers, insurance companies, attorneys, regarding their inquiries or requests for assistance.
- Compiled data from multiple sources in order to create comprehensive case files for each claim.
Remote Claims Specialist
WellCare
Houston, TX
12.2018 - 01.2022
- Receives and handles all incoming medical insurance claims
- Requests and analyzes relevant reports and hospital records
- Responsible for processing and authorizing the payment of medical claims, negotiating bills on an as-needed basis
- Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations
- Prepares reports by collecting, analyzing, inputting data entry to summarize information for approval
- Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter through facets healthcare tool
Sterile Processing Technician( PRN)
St Luke's Hospital
Sugar Land, TX
11.2018 - 10.2020
- Provide direct technical assistance to operation room staff on assigned cases
- Sorted, loaded, unloaded and decontaminated equipment and instruments according to procedures, sterilization of equipment and instruments
- Followed written and verbal instructions and performing multiple tasks; Inspected equipment and instruments, documentation of sterilization cycle, labeled products with sterilization date, collected used equipment and instruments
- Pull and/or complete case carts for next day case load; Utilized and/or run Steris machines and custom ultrasonic and autoclave machines daily
Sterile Processing Technician
Surgical Concepts & Innovations
Houston, TX
05.2017 - 11.2018
- Maintained accurate records of all sterilized items, including item number, date, time, type of sterilizer used, and operator initials.
- Performed decontamination of medical instruments and equipment to prepare for sterilization.
- Verified that all documents were completed accurately before releasing items from the sterile processing area.
- Distributed sterile and non-sterile supplies and medical equipment upon request or case cart requisition.
- Maintained records of inventory or equipment usage, ordering medical instruments or supplies with low inventory.
Intake Specialist Asst. Lead
Healix Inc.
Houston, TX
01.2016 - 01.2018
- Performs insurance benefits verification payers via telephone or web-based systems
- Performs pre-certification, obtains authorizations and referrals as required by payer guidelines
- Performed data entry into various computer systems including but not limited to EMRs and CRMs.
- Reviews and approves assigned orders utilizing department guidelines; Generate appropriate billing and coding worksheet
Appeals and Grievance Specialist
Universal American
Houston, TX
06.2015 - 01.2016
- Conducts investigation and review of customer grievances and appeals; Resolve inquiries, grievances and appeals requests from 3 customer types (i.e
- Member, provider and regulatory); Researches administrative or non-clinical aspects of the appeal, e.g
- Eligibility, benefit levels; Prepares files for internal or external review by analysts, medical staff or outside consultant
Claims Processor / Appeals and Grievance Coordinator
United Healthcare Group
Houston, TX
07.2011 - 06.2015
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Examined claims, records and procedures to grant approval of coverage.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Collected payments, processed receipts and informed policyholders of outstanding balances.
- Investigated customer complaints and provided solutions or advice in accordance with company policy.
- Maintained records of customer interactions by documenting notes in the computer system.
Education
Sterile Processing Technology
Fortis College - Houston
Houston, TX05.2017
Skills
- Administrative Support
- Case Management
- Filling Appeals
- Attorney Support
- Customer Service
- Verbal and Written Communication
- Communicating With Clients
- Proficiency in QNXT, Facets, EMR, Availity, NextGen , Epic &Care 360
Timeline
Claims Denial Litigation Specialist
Sullins Johnston Law Firm
01.2023 - Current
Records Research Specialist
Applicant Insight
05.2022 - 04.2023
Remote Claims Specialist
WellCare
12.2018 - 01.2022
Sterile Processing Technician( PRN)
St Luke's Hospital
11.2018 - 10.2020
Sterile Processing Technician
Surgical Concepts & Innovations
05.2017 - 11.2018
Intake Specialist Asst. Lead
Healix Inc.
01.2016 - 01.2018
Appeals and Grievance Specialist
Universal American
06.2015 - 01.2016
Claims Processor / Appeals and Grievance Coordinator
United Healthcare Group
07.2011 - 06.2015
Sterile Processing Technology
Fortis College - Houston
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