Shawanna Poitier
Dallas,TX
Summary
Skilled in handling complex insurance claims and policy processing with experience in navigating through various insurance software systems. Demonstrates strong analytical skills, adept at interpreting policies and efficiently resolving claims to the satisfaction of all parties involved. Known for maintaining high accuracy levels in document processing and data entry, contributing to streamlined operations and improved customer service outcomes. Continuously seeks ways to optimize workflows and enhance team productivity, leading to more efficient claim resolution processes.
Overview
15
15
years of professional experience
1
1
Certificate
Work History
Claims Representative
Capitol Claim Group
04.2025 - Current
- Managed claims processing ensuring accuracy and compliance with regulatory standards.
- Analyzed claim documentation to determine eligibility and resolve discrepancies.
- Facilitated communication between clients, insurers, and internal teams to expedite claim resolutions.
- Developed training materials for new hires on claims procedures and best practices.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Auto Field Adjuster
Geico
06.2024 - 03.2025
- Managed heavy workload of ongoing cases thanks to strong organizational, time management, and collaboration skills.
- Coordinate benefits while applying applicable deductibles, co-insurance and out of pocket costs.
- Provide customer support to members, providers, billing departments and other insurance agency’s regarding claims, appeals and eligibility.
- Solicited estimates and photographs on smaller losses with XACTWARE.
- Collaborated with policyholders and repair shops to facilitate timely claim resolutions.
- Conducted thorough inspections of vehicles and properties, documenting findings accurately.
- Enhanced customer satisfaction by providing timely and accurate auto damage assessments.
- Utilized advanced technology tools for more accurate damage assessments, such as 3D imaging software or mobile applications designed specifically for adjusters.
- Issued payouts to claimants.
- Negotiated with claimants to settle claims.
- Utilized advanced software tools to manage claim workflows and track case progress effectively.
- Proficient in multi software ad express, ccc, aws, engage.
MITIGATION SPECIALIST
Bio Busters Remediation
01.2020 - 01.2024
- Collaborated with clients and insurance companies to verify coverage, submit claims, and resolve billing discrepancies.
- Prepared and submitted detailed invoices for remediation projects, including labor, materials, and equipment used, while ensuring compliance with industry standards.
- Managed accounts receivable, tracking payments and following up with clients and insurance carriers to ensure timely settlements.
- Reviewed contracts and service agreements to ensure accurate billing based on the terms and conditions of each project.
- Maintained detailed records of remediation work completed, associated costs, and billing information for internal tracking and audits.
- Communicated with customers to clarify billing questions, resolve issues, and provide updates on payment status.
- Assisted in the preparation of reports for management on billing trends, outstanding balances, and financial performance of remediation projects.
- Maintained litigation docket and calendars for 3 attorneys, noting deadlines for responsive pleadings, motions and other important deadlines.
ACCOUNTS RECEIVABLES/CLAIMS COORDINATOR
Sage Dental
01.2018 - 01.2019
- Managed and processed medical claims, ensuring accurate coding, submission, and timely reimbursement from insurance carriers.
- Coordinated with healthcare providers and insurance companies to resolve billing discrepancies and ensure proper claim adjudication.
- Verified patient insurance eligibility and benefits, ensuring accurate claims submission in compliance with payer guidelines.
- Reconciled patient accounts, ensuring that all payments and adjustments were accurately applied to open balances.
- Monitored and tracked outstanding claims, following up with insurance carriers to expedite payment and resolve delayed claims.
- Prepared and submitted claims to insurance companies, ensuring adherence to billing codes, policies, and deadlines for timely processing.
- Assisted in reviewing and analyzing EOBs (Explanation of Benefits) to ensure proper payment and investigate any denied claims.
- Provided support to patients and internal teams by addressing billing inquiries, explaining charges, and facilitating payment arrangements.
- Generated and maintained accurate records of accounts receivables, tracking payments, adjustments, and outstanding balance.
- Completed bi-weekly payroll for 6 employees.
CASE MANAGER
Mid American Health
01.2011 - 01.2018
- Managed patient cases by reviewing medical records, verifying claims, and ensuring accurate data entry for efficient processing.
- Coordinated with healthcare providers, insurance companies, and patients to ensure accurate claims submissions and timely resolutions.
- Entered and maintained detailed case management data in electronic systems, ensuring accuracy and confidentiality in compliance with HIPAA.
- Analyzed claims data and identified discrepancies, collaborating with relevant parties to correct and resubmit claims for payment.
- Supported the claims process by verifying eligibility, coverage, and claim status, ensuring all necessary documentation was provided.
- Tracked and monitored open claims, escalating unresolved issues to senior management for further action and resolution.
- Provided clear and concise documentation on case progress and claim status updates to internal teams and external stakeholders.
- Assisted in preparing case reports and ensuring all data related to claims, payments, and resolutions was properly recorded and updated.
Education
High School Diploma -
James Madison High School
Norcross, GA05.2009
No Degree -
Broward College
Fort Lauderdale, FL01.
Skills
De-escalation techniques
Certification
- All lines Adjuster 6-20
- ICAR Platinum / Physical
- Damage Appraiser
- Mold Assessor
- Mold Remediator
Timeline
Claims Representative
Capitol Claim Group
04.2025 - Current
Auto Field Adjuster
Geico
06.2024 - 03.2025
MITIGATION SPECIALIST
Bio Busters Remediation
01.2020 - 01.2024
ACCOUNTS RECEIVABLES/CLAIMS COORDINATOR
Sage Dental
01.2018 - 01.2019
CASE MANAGER
Mid American Health
01.2011 - 01.2018
High School Diploma -
James Madison High School
No Degree -
Broward College