Summary
Overview
Work History
Education
Skills
Timeline
Generic

Shea Jones

St. Louis,MO

Summary

Results-oriented professional with a strong background in computers, risk analysis, and claims management. MBA in Business Management and Computer Science, complemented by a Bachelor of Science in Business Administration & Computer & Information Systems. Proven track record of success in identifying and mitigating risks, resolving complex issues, and driving the operational efficiency. Seeking a long term challenging position to leverage skills and expertise for organizational growth.

Overview

22
22
years of professional experience

Work History

EDI Analyst

W.R. Berkley Corporation
08.2023 - Current
  • - Effectively investigate and resolve electronic transaction errors, exceptions, and failures promptly and collaboratively with cross-functional teams, such as IT, operations, and customer service, to identify root causes and implement preventive measures
  • - Successfully work closely with internal stakeholders and external partners to analyze business requirements, design solutions, and implement system enhancements
  • Provide guidance and support to business users and technical teams involved in the processes
  • - Progressively conduct training sessions and provide ongoing support to end-users, helping them understand and effectively utilize the system
  • Address user queries, troubleshoot issues, and ensure smooth electronic transaction operations
  • - Effectively develop and implement monitoring tools and metrics to track the performance and reliability of electronic transaction processes
  • Proactively identify areas of improvement and recommend corrective actions as needed
  • - Meticulously mapped complex IT systems and handled database updates
  • - Productively work as project manager on multiple projects ensuring accuracy and timely completion
  • - Progressively stay updated on emerging technologies, trends, and advancements in EDI/cXML and related areas
  • - Participate in professional development activities, attend conferences, and network with industry professionals to enhance your skills and knowledge

Risk Analyst

Schnucks Market Inc.
05.2022 - 05.2023
  • - Developed and implemented risk assessment strategies, resulting in vast reduction in overall risk exposure
  • - Meticulously monitored and evaluated the effectiveness of risk controls and compliance measures, making recommendations for improvement
  • - Progressively worked with vendors, TPA(s), Attorneys, Case Managers, Brokers, and various other external as well as internal counterparts to aid in risk resolution
  • - Efficiently prepared and presented risk and compliance reports to senior management, highlighting key findings and recommendations
  • - Conducted thorough analysis of potential risks and provided recommendations to senior management for risk mitigation
  • - Progressively collaborated with cross-functional teams to ensure compliance with regulatory requirements, industry best practices and licensing
  • Temporary Role

Risk Analyst

Charter Communications
08.2017 - 05.2022
  • - Effectively oversaw risk assessment initiatives for multiple projects, resulting in improved risk identification and mitigation processes
  • - Productively managed vendor and all third-party relationships
  • In addition, assisted with contract negotiations and renewals
  • - Successfully developed and maintained risk management frameworks, policies, and procedures
  • - Developed and implemented risk assessment strategies, resulting in a vast reduction in overall risk exposure
  • - Conducted risk workshops and training sessions to enhance risk awareness and promote a risk-conscious culture within the organization
  • - Accurately monitored insurance laws, licensing, and regulations relevant to rate filings and reporting, products, and administration procedures
  • - Meticulously monitored and evaluated the effectiveness of risk controls and compliance measures, making recommendations for improvement
  • - Successfully collaborated with HR on succession planning, policy initiatives, loss prevention, and many other initiatives
  • - Conducted claim audits, claim reviews and quality assurance reviews to identify areas for improvement and implement process enhancements, resulting in increased efficiency and accuracy
  • - Productively prepared and presented risk and compliance reports to senior management, highlighting key findings and recommendations
  • - Worked as a key project manager ensuring the risk management program stayed within budget and compliance
  • - Progressively worked with vendors, TPA(s), Attorneys, Case Managers, Brokers, and various other external as well as internal counterparts to aid in risk resolution

Resolution Manager

Gallagher Bassett
06.2014 - 08.2017
  • - Effectively oversaw the resolution of high-value claims, ensuring compliance with company policies and regulatory requirements
  • - Successfully implemented process improvements that vastly reduced claim resolution time
  • - Conducted comprehensive investigations to determine liability and evaluate claims
  • - Productively managed a portfolio of complex casualty claims, ensuring timely and accurate resolution
  • - Performed project management duties to a large team of individuals enhancing the overall flow of claims management and bridging any gaps
  • - Successfully negotiated numerous settlements with claimants and attorneys, resulting in vast cost savings
  • - Effectively collaborated with legal counsel to develop litigation strategies and minimize potential liabilities
  • - Progressively attended trials, mediations and other proceedings when relevant

Team Leader

Progressive Insurance
09.2012 - 06.2014
  • - Managed a team of claims adjusters, providing guidance and support to ensure efficient claims handling
  • - Effectively oversaw the resolution of high-value claims, ensuring compliance with company policies and regulatory requirements
  • - Successfully conducted performance reviews on team members ensuring proper communications of goals, updates, and areas of improvement
  • - Developed and implemented training programs to enhance team members' technical skills and knowledge
  • - Collaborated with underwriters to identify potential risks and implement risk mitigation strategies

Senior Claim Adjuster

American Family Insurance
06.2007 - 08.2012
  • - Investigated and evaluated complex property and casualty claims, ensuring accurate coverage determination
  • - Negotiated settlements with claimants and third-party vendors, resulting in vast cost savings
  • - Consistently provided exceptional customer service, maintaining high customer satisfaction ratings
  • - Successfully trained new hires and created multiple creative helpful job aides overall enhancing the claim adjusting process
  • - Progressively worked closely with internal and external counterparts
  • - Effectively attended mediations, trials, claim reviews, and any other proceedings relevant

Placement Specialist

Career Center
01.2003 - 05.2007
  • - Effectively assisted students in identifying career goals and developing job search strategies
  • - Conducted workshops and seminars on resume writing, interview skills, and job search techniques
  • - Screened and interviewed candidates to assess their qualifications, experience, and cultural fit, resulting in a vast increase in the quality of hires
  • - Administered assessments and tests to evaluate candidates' skills, abilities, and suitability for specific roles
  • - Established and maintained relationships with employers to facilitate student placements

Education

Bachelor of Science - Business Administration, Computer & Information Systems

University Of Missouri
St. Louis, MO

MBA - Business Management, Computer Science

Webster University
St. Louis, MO
01.2019

Skills

  • - Proficient in risk/compliance assessment methodologies and tools
  • - Strong project management, analytical, data analysis, and problem-solving abilities
  • - Excellent communication and interpersonal skills
  • - Detail-oriented with a strong focus on accuracy
  • - Strong Presentation and sales skills
  • - Proficient in Microsoft Office Suite, SQL, Power-BI, Python, dashboards, tableau and risk management software
  • - Contract, underwriting, and Account Management proficiency
  • - Knowledge of OSHA, HIPPA, Salesforce, Service Now, licensing, renewals, and many other state compliance laws and regulations

Timeline

EDI Analyst

W.R. Berkley Corporation
08.2023 - Current

Risk Analyst

Schnucks Market Inc.
05.2022 - 05.2023

Risk Analyst

Charter Communications
08.2017 - 05.2022

Resolution Manager

Gallagher Bassett
06.2014 - 08.2017

Team Leader

Progressive Insurance
09.2012 - 06.2014

Senior Claim Adjuster

American Family Insurance
06.2007 - 08.2012

Placement Specialist

Career Center
01.2003 - 05.2007

Bachelor of Science - Business Administration, Computer & Information Systems

University Of Missouri

MBA - Business Management, Computer Science

Webster University

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Shea Jones