Shaunee Caldwell
Jackschville,Florida
Summary
Experienced customer relations specialist dedicated to achieving results while providing quality and personalized service. Organized and knowledgeable in healthcare with 15 years of experience in medical field. Excellent typist, collaborator and office coordinator with proven history of reorganizing and optimizing office settings. Dedicated to efficiency and maintaining workflow. Meticulous Claims Investigator effective at collecting and analyzing data used to devise fair and cost-effective settlements. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Claim Examiner
AmeriHealth Caritas
12.2020 - Current
- Process 120-160 daily
- Meets daily metrics of procedural and financial accuracy
- Review and analyze claims quickly and efficiently to ensure proper turn around time
- Review emails before each shift and as they come in during the day to be aware of any policy changes and/or updates
- Works independently and uses all available resources to ensure accuracy and efficiency
- Utilizes all company resources to make sure correct logic is applied to each claim
- Eagerly assist other teammates with questions they may have with claims, or refer them to the correct topic in our company resources.
Assistant Dean of Pledges
Gamma Sigma Sigma National Service Sorority
11.2013 - Current
- Oversee the membership intake process with the dean of pledges
- Collaborate with members to organize volunteer events and service activities
- Partner with local charities to provide monetary, physical and emotional support to those in need.
Junior Processor
NewRez LLC
12.2020 - 12.2021
- Gathered Documents for clients to ensure a smooth refinance process
- Ensure the job of the loan processor is less stressful because of my research and diligence
- Called agencies for the borrower to ensure they were up to date on hazard and flood insurance
- Called clients as needed to verify important information that would make their refinance as quick as possible
- Always ensured professionalism internally and externally
- Sent emails to clients to follow-up with their progress as well as respond to emails from clients checking their loan progress.
Desk Operations Specialist
The Mayo Clinic
Jacksonville, FL
12.2019 - 12.2020
- Scheduled and confirmed patient appointments for diagnostic, surgical and consultation services
- Supported administrative and healthcare staff, provided order fulfillment and inventory management services to ease operations
- Managed front office customer service, appointment management, billing and administration tasks to streamline workflow
- Answered phone calls to provide clients assistance in scheduling appointments worked closely with medical personnel to maximize office efficiency
- Managed physicians calendar, including scheduling patient appointments and procedures
- Answered about 35-40 calls daily to schedule appointments and address patient inquiries
- Addressed, documented, and responded to incoming correspondences to address client queries.
Case Manager
Aetna
12.2017 - 05.2019
- Effectively communicated with internal and external customers regarding medical benefits, claims and scheduling
- Properly evaluated high risks clients to proactively assign case managers to the appropriate region
- Utilized Microsoft Office to assess availability of clientele and case workers which ensured company and jurisdictional guidelines were upheld
- Made 40 or more calls daily to introduce new clients to what is available to them under the medical plan.
Outbound Enrollment Specialist
AmeriHealth Caritas
03.2014 - 09.2017
- Provided personalized recommendations to customers regarding their Medicaid benefits
- Thoroughly researched and documented information retrieved from customers to ensure their medical needs were properly evaluated
- Utilized all available resources to accurately explain products and benefits
- Practiced quality handling by remaining organized and focused on company goals
- Consistently met and exceeded results and expectations while maintaining quality assurance
- Proactively recognized areas of opportunity which led to enhanced results and a modification of call center scripts and processes
- Developed a rapport with customers to ensure they remained on track with their health care regimen, leading to increased customer satisfaction.
Customer Service Representative
Aetna
05.2006 - 02.2014
- Practiced quality claim handling by communicating benefits and healthcare options with customers
- Selected by leadership to manage complaints and appeals
- Selected to participate on various projects including, but not limited to, broker partnerships and contract communications
- Effectively communicated with clients while proactively managing customer accounts
- Delivered exceptional customer service with internal and external customers.
Education
Bachelors of Business Management -
University of Phoenix
01.2013
Skills
- Microsoft Suite
- Rumba Facets
- LexisNexis
- Verint
- MedCompass Internet Explorer
- Call center
- Customer satisfaction
- Customer service
- Internet Explorer
- Processes
- Quality
- Rapport
- Rumba
- Scheduling
- Scripts
- Six Sigma
- Business operations
- Communications
- Problem resolution
- Administrative support
- Planning and coordination
- Organization Experience
- Insurance Knowledge
- Claims Investigation
- Policy Interpretation
- Relationship Building
- Case Presentation
- Claims Evaluation
- Claims Processing
- Team Collaboration
- Decision-Making
- Liability Determination
- Critical Thinking
- Policy Investigations
- Active Listening
- Continuous Improvement
- Public Speaking
- Computer Skills
- Analytical Skills
- Attention to Detail
- Goal Setting
- Coaching and Mentoring
- Team Leadership
- Multitasking
- Problem-Solving
- Reliability
- Adaptability and Flexibility
- Written Communication
- Professional Demeanor
- Organizational Skills
- Excellent Communication
- Benefit Explanation
- Customer Service and Support
- Allocating Claims
- Time Management
- Problem-Solving Aptitude
- Self Motivation
Certification
Six Sigma White Belt Certification, 2011
References
References available upon request.
Timeline
Claim Examiner
AmeriHealth Caritas
12.2020 - Current
Junior Processor
NewRez LLC
12.2020 - 12.2021
Desk Operations Specialist
The Mayo Clinic
12.2019 - 12.2020
Case Manager
Aetna
12.2017 - 05.2019
Outbound Enrollment Specialist
AmeriHealth Caritas
03.2014 - 09.2017
Assistant Dean of Pledges
Gamma Sigma Sigma National Service Sorority
11.2013 - Current
Customer Service Representative
Aetna
05.2006 - 02.2014
Bachelors of Business Management -
University of Phoenix
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