Sharron Stevenson
Houston
Summary
Dynamic Claim Examiner with extensive experience at ELEVANCEHEALTH, excelling in claims investigation and process optimization. Proven track record of managing high-volume claims while delivering exceptional customer service. Adept at navigating complex regulations, ensuring compliance, and enhancing operational efficiency through critical thinking and effective communication.
Overview
9
9
years of professional experience
Work History
Claim Examiner
ELEVANCEHEALTH
02.2023 - Current
- Review medical claims to determine if they are related to the accident
- Create itemization for reimbursement
- Make calls to the Attorney/ Claim adjuster
- Research claims gather information to process claims
- Determine state rights, reimbursement rights, ERISA/Non-ERISA
- Closing claims, moving claims to begin reimbursement
Claim Examiner
SEDGWICK
08.2021 - 02.2023
- Determine leave eligibility, reviewing employees for all leave benefits
- Designate leave as FMLA qualifying, STD, PLOA, or State leave
- Educating employees on the leave process
- Request medical certification
- Communicate with employees regarding their needs for leave and/or modified work schedules.
- Ensures that employees are aware of their responsibilities and of any documentation and notice required to qualify for and to take leave.
- Completing the productivity of a hundred claims a day, responding to emails, voicemails, and texts
Patient Navigator
ST. VINCENT HOSPITAL
Indianapolis
08.2017 - 03.2020
- Registered patients, verified insurance & eligibility, transfer from IN/OUT status, on-call rotation with Team Lead
- Greet the patient, answer general questions
- Obtained prior authorizations, assisted physicians with orders and procedure scheduling
- Researched root cause of claims and billing issues and trends, prioritized patients’ billing/financial questions
- Identified process improvement opportunities to streamline the workflow process
- Performed peer-to-peer performance reviews and conducted peer interviews for potential new hires
- Mentored and trained new employees on systems
- Conducted multiple team activities, developed and created a competitive environment
Member Service Representative
DEFENDERS
Indianapolis
10.2016 - 02.2019
- Provider for ADT security systems
- Receiving inbound calls regarding billing, technical support, and installments
- Provided plan information and education to customers while displaying customer engagement
- Assisted with special projects as assigned
- De-escalate irate customer
- Maintained astounding productivity levels, demonstrated accountability and high performance
Education
Some College (No Degree) - Psychology
Houston Christian University
7502 Fondren Rd, Houston, TX 77074Skills
- Microsoft Office proficiency
- Coverage analysis
- Liability and coverage
- Policy interpretation
- Claims investigation
- Critical thinking
- Customer service excellence
- Order fulfillment
- Process optimization
- Telecommunications expertise
- Call center operations
- Organizational skills
- Medicare and Medicaid knowledge
- Managed care coordination
- Claims processing
- FMLA and STD administration
- Accounts receivable billing
Timeline
Claim Examiner
ELEVANCEHEALTH
02.2023 - Current
Claim Examiner
SEDGWICK
08.2021 - 02.2023
Patient Navigator
ST. VINCENT HOSPITAL
08.2017 - 03.2020
Member Service Representative
DEFENDERS
10.2016 - 02.2019
Some College (No Degree) - Psychology
Houston Christian University