Shaundre Emmerson
Summary
Claims Examiner with a deep knowledge of Long Term Disability in the claims industry. Solid abilities in developing objectives and strategies to settle Disability claims. Excellent skills compiling, coding, categorizing and auditing information to process claims.
Ability to handle multiple projects simultaneously with a high degree of accuracy. Trustworthy and dependable. Detailed- oriented team player with strong organizational skills.
Overview
18
18
years of professional experience
Work History
LTD Claims Examiner
Lincoln Financial Group
02.2021 - Current
- Managed claims with longer durations and evolving medical conditions.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Utilized ICD-9 and ICD-10 to aid in processing of claims, verified member participation and process claims in accordance with network designation.
- Developed and documented Strategic Plans that focused on the future direction of the claim using a holistic viewpoint.
- Ensured timely research, investigated and follow up on necessary eligibility requirements such as: Pre Existing Conditions and Limitations, Any Occupation/Regular Occupation.
- Documented any additional information or specific action taken using proper systems, for calculating complex benefits on a monthly basis.
- Calculated and verified offsets for Short Term Disability, Social Security Disabililty Insurance, Workers Compensation, etc.
- While determining customer eligibility I interacted with employers, physicians, internal business matrix partners, attorneys etc.
- Effectively organized, prioritized, multi-tasked and follow detailed instructions and made independent decisions on their ongoing medial leave.
- Maintained above 90% in quality and production and was responsible for complex claim blocks of 75-100 LTD claims.
- Continued follow up tasks to ensure the customers understanding of their claim by executing fair, accurate and timely decisions.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Worked directly with Vocational Rehabilitation Counselors to facilitate a return to work fulltime or a modified schedule.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Examined photographs, statements, medical summary visits, etc.
Project Coordinator
Johns Hopkins Hospital
05.2015 - 02.2021
- Assigned classes to Clinical Instructor Support Education Courses.
- Responsible for Exam Proctoring using Epic User Web for over 400 providers, nurses, instructors, and other staff.
- Answered phones and greeted users as they attended training sessions.
- Assigned classes to CIS Educators. as well as entering class assignments within JHMI LMS system.
- Processed Epic courses into LMS, assigned training rooms, assigned instructors to teach courses, cancelled courses due to 0 enrollment.
- Liaised between departments to facilitate communication and keep appropriate parties updated on project developments.
- Assembled manuals for team usage from vendor-supplied product data sheets and submittal information.
- Tracked hours and expenses to keep project on task and within budgetary parameters.
- Prepared meeting agendas and minutes for distribution and record keeping.
- Enhanced team collaboration through regular meetings, fostering a positive work environment for increased productivity.
- Supervised multiple projects from project start through delivery by prioritizing needs and delegating assignments.
- Kept projects on schedule by managing deadlines and adjusting workflows.
- Worked effectively in fast-paced environments.
Instructional Support Specialist
Laureate Education Inc.
04.2009 - 11.2014
- Provided customer service , administrative support, and first line technical support for Learning Management Systems (LMS).
- Responsible for daily production including monitoring, generating documents, and applying premium on policies.
- Managed over 2500 course enrollments as well as course assignments within LMS.
- Built ad maintained virtual classroom environments by uploading and modifying course content in Blackboard and LMS.
- Ensured that all materials were prepared, reviewed and received for release of policies.
- Teamed with subject matter experts in evaluation and revision of training tools in order to continually improve learning platforms.
- Used Adobe Dreamweaver daily to create and edit HTML pages.
Graduation Coordinator/ Degree Auditor
Laureate Education Inc.
03.2006 - 04.2009
- Resolved discrepancies between enrolled courses and needed courses.
- Worked with students one-on-one to pick classes coinciding with educational plans.
- Received student applications and schedules and compared classes against graduation requirements.
- Approved student schedules and classes to begin semester.
- Reviewed student credit hours to help students meet graduation requirements.
- Validated students after their completion of their required work.
- Evaluated and revised over 8500 academic records.
- Audited grades, credits, and degrees awarded.
- Recruited and trained over 30 new staff members.
- Coordinated and supervised academic advising activities.
- Delivered supportive and knowledgeable counseling to students with academic or personal concerns.
- Monitored student progress to drive successful academic outcomes.
- Resolved discrepancies between enrolled courses and needed courses.
- Reviewed student credit hours to help students meet graduation requirements.
Education
MBA - Business Administration
Walden University
Minneapolis, MN12.2010
Bachelor of Arts - Human Resources Management
Walden University
Minneapolis, MN05.2006
Skills
- Claims Understanding
- Data Verification, ICD-10
- Disability Claims Process
- Claims/Policy Investigations
- Compensation Management
- Critical Thinking
- Denied Claims Identification
- Analytical Skills
- Interpersonal Skills
- Policy Interpretation
- Verbal Communication
- Coding Systems
Timeline
LTD Claims Examiner
Lincoln Financial Group
02.2021 - Current
Project Coordinator
Johns Hopkins Hospital
05.2015 - 02.2021
Instructional Support Specialist
Laureate Education Inc.
04.2009 - 11.2014
Graduation Coordinator/ Degree Auditor
Laureate Education Inc.
03.2006 - 04.2009
MBA - Business Administration
Walden University
Bachelor of Arts - Human Resources Management
Walden University
Similar Profiles
Darius GuilloryDarius Guillory
Analyst, Application Development (Dataiku IT Administrator) at Lincoln Financial GroupAnalyst, Application Development (Dataiku IT Administrator) at Lincoln Financial Group
Joanna MurphreyJoanna Murphrey
Disability Claims Examiner at Lincoln Financial GroupDisability Claims Examiner at Lincoln Financial Group
Crystal PickeringCrystal Pickering
Complex Disability Manager II at Lincoln Financial GroupComplex Disability Manager II at Lincoln Financial Group
Jonathan JamesJonathan James
Senior Account Director at Lincoln Financial GroupSenior Account Director at Lincoln Financial Group
Erika NielsenErika Nielsen
Honolulu - Customer Service Representative/Medical Claims Examiner/Liability Claims Examiner at GEICOHonolulu - Customer Service Representative/Medical Claims Examiner/Liability Claims Examiner at GEICO