Shanteria Hall
Fort Lauderdale,FL
Summary
Professional with extensive experience in claims processing and medical billing, adept at preparing detailed reports on trends in denials and appeals. Demonstrated ability to evaluate customer complaints, identify root causes, and implement corrective actions effectively. Developed training materials for medical claims processing, ensuring compliance with healthcare regulations and HIPAA standards. Proven track record in resolving denied claims promptly while maintaining meticulous records of all claims-related activities.
Overview
11
11
years of professional experience
Work History
Medical Claims Representative
Teleperformance
North, FL
11.2023 - 06.2025
- Prepared detailed reports on trends in denials, rejections, appeals, collections.
- Evaluated customer complaints, identified root causes, and took corrective action as appropriate.
- Developed training materials related to specific topics within the scope of medical claims processing.
- Investigated and resolved denied or rejected claims quickly and accurately.
- Assisted customers with inquiries about the status of their claims via telephone or email.
- Maintained detailed records of all activities related to claims processing.
- Processed payments from various insurance companies according to their guidelines.
- Administered standard contract benefits to process pending claims for dental benefits.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
Verification Specialist
Willis Towers Watson
Fort Lauderdale, FL
04.2022 - 06.2023
- Maintained detailed records of customer verifications and associated documentation.
- Reviewed incoming documents for completeness, accuracy, and compliance with established standards.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Verified patient insurance coverage, benefits, and eligibility for services across multiple insurance platforms.
- Handled billing related activities focused on medical specialties.
- Accessed third-party insurance databases to identify coverage of benefits.
- Educated patients on their insurance benefits and coverage limitations.
Customer Service Specialist
Humana
Deerfield Beach, Florida
04.2018 - 10.2021
- Responded to customer emails with accurate product and service information.
- Provided assistance to customers in navigating website, placing orders, and resolving complaints.
- Maintained up-to-date knowledge of product features and benefits.
- Performed data entry of customer orders into the company's order management system.
- Researched complex issues raised by customers, identified solutions, and provided timely responses.
- Maintained a high level of professionalism while interacting with customers via phone or email.
- Investigated escalated customer complaints utilizing problem-solving skills to identify root causes of issues.
- Assisted customers with account maintenance such as resetting passwords and updating contact information.
- Assisted customers with making payments or establishing payment plans to bring accounts current.
- Documented customer correspondence in CRM to track requests, problems, and solutions.
- Informed customers about billing procedures, processed payments, and provided payment option setup assistance.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
Claims Representative
Choice Medical Group
Fort Lauderdale, FL
06.2014 - 08.2017
- Maintained detailed records of all communication with customers, claimants, providers, and internal departments.
- Collaborated with other departments to resolve billing disputes or address customer concerns quickly.
- Reviewed and verified claim information to ensure accuracy of data and compliance with established policies.
- Ensured timely submission of required documentation from claimants prior to approval of payment.
- Filed appeals on behalf of customers when necessary after denial of a claim due to insufficient evidence.
- Processed a high volume of claims efficiently while maintaining quality standards.
Education
High School Diploma -
Boyd Anderson High School
Fort Lauderdale, FL06-2008
Skills
- Claims processing
- Medical coding
- Insurance verification
- Claims appeals
- Customer service
- Billing procedures
- Microsoft office
- Medical billing
- Medical software
- Healthcare regulations
- Medical Terminology Familiarity
- Documentation skills
- Prior authorization processing
- Payment posting
- Data inputting
- Data entry and management
Timeline
Medical Claims Representative
Teleperformance
11.2023 - 06.2025
Verification Specialist
Willis Towers Watson
04.2022 - 06.2023
Customer Service Specialist
Humana
04.2018 - 10.2021
Claims Representative
Choice Medical Group
06.2014 - 08.2017
High School Diploma -
Boyd Anderson High School