Shantel Lomax

To utilize three pillars of strength- Integrity, intelligence and a good energy to increase productivity and operational excellence within the company. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

• Community Service Coordinator
• Mentor
• Volunteer

• Aetna, 01/01/07, Present, Care Management Associate, Verify Maternity Insurance coverage and eligibility for both Members and Providers, Complete Authorizations and Referrals for Maternity cases, Assist members with completing the pregnancy risk assessment to determine if there are any risk factors associated with their pregnancy, Task Members to appropriate Nurse Case Manager who will assist and follow them throughout their pregnancy
• Aetna, 01/01/03, 12/31/07, Provider Service Representative, 01/01/06, 12/31/07, Verify and explain benefits, contract, rates and precertification to providers, Verify Insurance coverage and eligibility, Complete targets to have claims processed and reprocessed, Inform Providers of claim status, Customer Service Representative, 01/01/03, 12/31/06, Responsible for processing Authorizations and Claims for Members, Verify Members Insurance coverage, Eligibility and Benefits, Inform Members of Claim Status, Rate Schedules and Processing Procedures