Sharon Nelson
Summary
Dedicated insurance professional with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
9
9
years of professional experience
4
4
years of post-secondary education
Work History
Claims Supervisor
Catalyst Solutions
09.2022 - Current
- Cultivated productive relationships with stakeholders, facilitating claims lifecycle.
- Monitored team performance, enforcing compliance with corporate claims processes and procedures.
- Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times.
- Investigated, evaluated and adjusted multi-line claims in accordance with standards and laws.
- Created successful work schedules for each team member to maintain deadlines and fully staff shifts.
- Mentored newly hired employees on operating equipment and safety and developed training manual to use for reference.
- Evaluated staff performance and provided coaching to address inefficiencies.
TPL Specialist
Catalyst Solutions
02.2022 - 09.2023
- Negotiated settlements with claimants attorneys, other carriers and members.
- Reviewed new files to determine current status of injury claim and to develop a plan of action.
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Collected and tracked evidence in support of legal process
- Identified insurance coverage limitations with thorough examination of claims documentation and related records.
- Followed stated guidelines for handling Workers Compensation and any Subrogation Claims.
Enrollment Supervisor
BroadPath Healthcare Solutions
10.2021 - 02.2023
- Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
- Improved customer satisfaction scores through application of superior conflict resolution and problem-solving skills.
- Built highly-efficient administrative team through ongoing coaching and professional development opportunities.
- Coordinated individual duties after careful evaluation of each employee's skill level and knowledge.
- Reviewed statistic enrollment data and prepared reports.
Medicare Enrollment Supervisor
Blue Cross Blue Shield Of Texas
Richardson, TX
08.2019 - 02.2021
- Improved office operations by automating client correspondence, record tracking and data communications.
- Finalized and processed enrollment applications.
- Reviewed audit and monitoring reports related to consumer and client activites. Managed practical action plans to respond to audit discoveries and compliance violations.
- Hired, managed, developed and trained staff, established and monitored goals and conducted performance reviews.
- Built highly-efficient administrative team through ongoing coaching and professional development opportunities.
Consultant (YUM Brand)
RCG Consulting Services
Plano, TX
05.2016 - 08.2019
- Delivered outstanding service to clients to maintain and extend relationship for future business opportunities.
- Supported clients with business analysis, documentation, and data modeling.
- Liaised with customers, management, and sales team to better understand customer needs and recommend appropriate solutions.
- Onboarded and managed new client accounts to boost retention rates.
- Developed effective improvement plans in alignment with goals and specifications.
- Developed and updated tracking spreadsheets using Salesforce.
Consultant (Centene)
BroadPath Healthcare Solutions
San Antonio, TX
11.2014 - 05.2016
- Liaised with risk management, internal audit and employee services departments to direct compliance issues to appropriate channels for investigation and resolution.
- Performed quality control reviews of customer service representatives both inbound and out bound calls to check adherence with federal and state regulatory requirements.
- Maintained current knowledge of health insurance products and applicable enrollment requirements, processed, procedures, internal policies and regulations.
- Directed and implemented strategic improvement plans to integrate solutions to audit findings and workflow process issues.
- Served as subject matter expert by advising staff and customers and working directly with external agencies throughout audits or to remedy compliance issues.
Education
High School Diploma -
Watson Chapel High School
Pine Bluff, AR 08.1988 - 05.1990
Political Scie
University of Arkansas At Pine Bluff
Pine Bluff, AR 09.1990 - 05.1993
Skills
Insurance policy review
Claims investigation and research
Claims analysis
Medicare and Medicaid eligibility
Staff Management
Relationship building and management
Process implementation
Timeline
Claims Supervisor
Catalyst Solutions
09.2022 - Current
TPL Specialist
Catalyst Solutions
02.2022 - 09.2023
Enrollment Supervisor
BroadPath Healthcare Solutions
10.2021 - 02.2023
Medicare Enrollment Supervisor
Blue Cross Blue Shield Of Texas
08.2019 - 02.2021
Consultant (YUM Brand)
RCG Consulting Services
05.2016 - 08.2019
Consultant (Centene)
BroadPath Healthcare Solutions
11.2014 - 05.2016
Political Scie
University of Arkansas At Pine Bluff
09.1990 - 05.1993
High School Diploma -
Watson Chapel High School
08.1988 - 05.1990