Sharita Sanders
Tampa,FL
Summary
Detail-oriented Claims Analyst with 10+ years of experience in insurance claims processing, regulatory compliance, and customer service. Proven ability to evaluate workflows, interpret policy changes, and recommend best practices to improve efficiency and quality. Skilled in critical thinking, decision-making, and delivering results in fast-paced, deadline-driven environments
Overview
11
11
years of professional experience
Work History
Claims Analyst
Elevance Health
Tampa, FL
11.2023 - 04.2025
- Efficiently processed and adjudicated claims in accordance with company policies, industry regulations, and client-specific guidelines.
- Analyzed claim data to identify trends, patterns, and potential fraud, ensuring accuracy and minimizing risk.
- Maintained detailed records of claims activity, preparing reports for management on claims trends, outcomes, and key performance metrics.
- Assessed the validity of claims, determined coverage eligibility, and processed payments or denials based on policy terms, reduced claim processing time and improved customer satisfaction.
Claims A/R Follow Up
Womens Health Care
Tampa, FL
06.2022 - 09.2023
- Full knowledge of working in-network & out of network claims, familiar with Government payers - Medicare & Medicaid, Commercial payers, and Third-party payers.
- Audits Patient Account and when necessary, issues or request a refund to the patient or payer, identifies recoupments and determine if it was truly due or if another action can be taken to resolve and have claim finalized for payment.
- Contacts Insurance companies to check claim status, timely filing deadlines, claims address and electronic payer ID and verifies if still able to act on aging claims.
- Identifies if prior-authorizations or referrals are required by patients plan and attempts to obtain a retro-authorization and/or referral.
Billing Specialist
Bisk Education
Tampa, FL
06.2019 - 12.2021
- Processed invoices for student tuition through third-party payors, ensuring compliance with billing procedures.
- Identified and resolved billing variances to maintain system accuracy and currency, contributing to quality standards.
- Delivered exceptional customer service on collection calls and maintained professional demeanor to support production goals.
Claims Processor
Health Plan Services
Tampa, FL
12.2013 - 03.2019
- Evaluated accuracy and quality of data entered agency management system and generated, posted, and attached information to claim files.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
Education
Graduate Certificate - Medical Billing
Hillsborough Community College
Tampa, FL05.2022
High School Diploma -
Middleton High School
Tampa, FL05.2009
Skills
- Claims Pro
- Claims analysis and review
- Interpersonal and written communication
- Policy interpretation
- Data interpretation
- Customer service and support
- Critical thinking
- Active listening
- Records review
- Decision-making
- Microsoft Office Suite
- Team leadership and collaboration
- Relationship building
- Report and records review
References:
Available Upon Request
Timeline
Claims Analyst
Elevance Health
11.2023 - 04.2025
Claims A/R Follow Up
Womens Health Care
06.2022 - 09.2023
Billing Specialist
Bisk Education
06.2019 - 12.2021
Claims Processor
Health Plan Services
12.2013 - 03.2019
Graduate Certificate - Medical Billing
Hillsborough Community College
High School Diploma -
Middleton High School