Sheila Hall-Caldwell
Humble,TX
Summary
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
24
24
years of professional experience
Work History
Safety Supervisor
Mv Transportation Inc.
05.2019 - 01.2023
- Completed workplace safety and hazard inspections.
- Offered staff coaching on observed at-risk work habits to minimize accidents and increase workplace safety.
- Analyzed onsite incidents and instituted precautionary measures to reduce risk and severity of workplace injuries.
- Monitored safety practices of new and existing employees.
- Trained company employees in safety procedures and provided in-depth documentation for review.
- Recognized, documented and advised on removal of hazards.
- Achieved zero safety incidents for 0 years.
- Developed safety training procedures and authored manuals for distribution to staff members.
- Gathered information, prepared reports, and drafted correspondence related to cases.
- Implemented safety training and traffic safety instructional courses which bolstered improvements in safety culture across personnel groups.
- Verified monthly practice of fire drills for every work shift.
- Wrote, coordinated and delivered mass educational briefings focused on occupational accident trends and prevention.
- Completed workplace safety and hazard inspections
- Instructed employees on OSHA standards
- Participated in safety meetings by answering questions from staff members
- Kept main work areas free of debris and obstacles that could cause falls and mishaps
- Inspected work practices and procedures for compliance with company and federal regulations
- Monitored safety practices of new and existing employees
- Conducted regular safety inspections and audits to identify potential hazards and prevent accidents and injuries
Claims Processor
Mv Transportation
05.2020 - 12.2022
- Evaluated accuracy and quality of data entered into agency management system.
- Followed up with customers on unresolved issues.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
- Investigated properties to determine extent of damage and estimate repair costs.
- Reported policy changes and company conditions affecting customer satisfaction.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Checked documentation for accuracy and validity on updated systems.
- Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
- Verified client information by analyzing existing evidence on file.
- Generated, posted and attached information to claim files.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Processed and recorded new policies and claims.
- Calculated adjustments, premiums, and refunds.
Nurse Technician
V A Hospitals State And Long Term . Plus
02.2019 - 10.2022
- Maintained patient stability by checking vital signs and weight.
- Monitored, tracked and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
- Provided activities of daily living by assisting with serving meals, ambulating, turning and positioning patients.
- Obtained biological specimens for ordered tests and prepared for laboratory transport.
- Provided personal hygiene assistance, giving baths and performing dress changes for patients.
- Administered medication according to each patient's medical charts and recorded vitals such as blood pressure, temperature, and pulse.
- Aided patients with personal hygiene by giving baths, dressing and assisting in feeding.
- Maintained stringent hygiene standards of unit with disinfection and consistent restock of all equipment.
- Assisted patients with mobility by providing physical support and pushing wheelchairs.
- Corresponded with appropriate doctors to report any changes occurring in patients' health.
- Evaluated patients to identify and address wounds, behavioral concerns and medically relevant symptoms.
- Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care.
- Aided patients with personal hygiene by giving baths, dressing and assisting in feeding
- Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery
Claims Associate
Goodcare Home Health Services
02.2008 - 09.2016
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Confirmed appointments, communicated with clients and updated client records.
- Managed multiple tasks and met time-sensitive deadlines.
- Provided clerical support to company employees by copying, faxing and filing documents.
Safety Supervisor
Shell Oil
03.2014 - 02.2016
- Completed workplace safety and hazard inspections.
- Offered staff coaching on observed at-risk work habits to minimize accidents and increase workplace safety.
- Analyzed onsite incidents and instituted precautionary measures to reduce risk and severity of workplace injuries.
- Monitored safety practices of new and existing employees.
- Led employee training on safe usage of equipment.
- Reviewed company processes and suggested methods that would improve overall safety for all employees.
- Implemented [Task] and [Task] to improve safe operations regarding environmental hazards and risks.
- Shared health and safety tips with staff effectively lowering ENR score by [Number] points.
- Recognized, documented and advised on removal of hazards.
Bath Associate
Colonial Oaks Living Center
05.2005 - 03.2007
- Approached each problem with fresh mind and analytical strategies to quickly resolve concerns.
- Assisted with dining room set up prior to and after service period.
- Helped patients effectively manage routine bathing, grooming and other hygiene needs.
- Reported unusual or urgent circumstances in patients' condition or environment immediately to nurse supervisor.
- Answered call lights and supported patient comfort and safety by adjusting bed rails and equipment.
- Maximized patient satisfaction by helping individuals carry out personal tasks such as dressing and walking.
- Utilized nursing knowledge to identify patient needs and offer appropriate remedies.
- Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
Merchandise Associate
Academy Sports And Outdoors
03.2003 - 02.2005
- Transported merchandise to sales floor and restocked shelves, racks and bins.
- Greeted, serviced and thanked all customers.
- Organized store merchandise racks and displays to promote and maintain visually appealing environments.
- Answered customer questions regarding store merchandise, department information and pricing.
Patient Care Coordinator
St Luke's Healthcare System
01.1999 - 04.2003
- Acted as main point of contact for patients, doctors and hospital staff by closely reviewing medical charts and maintaining high levels of communication.
- Worked closely with patients to deliver excellent and direct individualized patient care.
- Delivered excellent patient experiences and direct care.
- Maintained confidentiality of patient data and condition to safeguard health information.
- Worked closely with patients to deliver excellent and direct individualized patient care
- Delivered excellent patient experiences and direct care
- Upheld confidentiality requirements and regulatory compliance guidelines
- Worked with patients to schedule tests and procedures
- Assisted patients with completing necessary paperwork and forms to provide healthcare facilities with essential information to bill for services
- Monitored patient health records for accuracy to meet compliance with healthcare guidelines
- Performed as subject matter expert for case management processes
- Verified patient insurance eligibility and entered patient information into system
Education
No Degree - Law Enforcement Investigation And Interviewing
Strafford Careers
Saint Albans, VT01.2023
No Degree - Law
Barclay
Houston, TX02.1998
High School Diploma -
Smiley / Jack Yates
1000 Mesa RD05.1987
Skills
- Accident Reporting
- Safety
- Safety Program Development
- Customer Feedback
- Information Updates
- Status Updates
- Data Communications
- Microsoft Office
- Office Organization
- Transactions reconciliation
- Claims review
- Claims
- Reporting skills
- Documentation abilities
- Self-Motivated
- Good Telephone Etiquette
- Decision-Making
- Problem-Solving
Accomplishments
- Received a job promotion within 6mths months of hire date.
- Achieved Certificate by completing [Task] with accuracy and efficiency.
Timeline
Claims Processor
Mv Transportation
05.2020 - 12.2022
Safety Supervisor
Mv Transportation Inc.
05.2019 - 01.2023
Nurse Technician
V A Hospitals State And Long Term . Plus
02.2019 - 10.2022
Safety Supervisor
Shell Oil
03.2014 - 02.2016
Claims Associate
Goodcare Home Health Services
02.2008 - 09.2016
Bath Associate
Colonial Oaks Living Center
05.2005 - 03.2007
Merchandise Associate
Academy Sports And Outdoors
03.2003 - 02.2005
Patient Care Coordinator
St Luke's Healthcare System
01.1999 - 04.2003
No Degree - Law Enforcement Investigation And Interviewing
Strafford Careers
No Degree - Law
Barclay
High School Diploma -
Smiley / Jack Yates
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