Summary
Overview
Work History
Education
Skills
Timeline
Generic

Shelitha Banks

San Antonio,TX

Summary

Analytical Claims Manager managing internal functions of teams, promoting high levels of quality production and overseeing specialized operational functions. Constructed concurrent objectives to promote efficiency and influence positive outcomes. Dedicated to team success while solving problems with minimal oversight.

Overview

10
10
years of professional experience

Work History

Supply Chain Risk & Claims Manager

Krispy Kreme
Charlotte, NC
05.2023 - Current
  • Facilitates process of obtaining essential data for claim setup
  • Handle and resolved inquiries from claimant, insured, and medical provider relating to claim status.
  • Maintain compliance with regulatory policies and guidelines for paying medical claims
  • Identify viable payer(s) by obtaining all necessary documentation for proper claim processing, which may include IBs, UBs, medical records, and POs.
  • Engage in effective communication and interaction with individuals involved in accidents including patients, insurers, attorneys and witnesses to acquire relevant data for financial claims
  • Interface with internal and external counsel on sensitive claims.
  • Coordinate with field adjusters and nurse case managers to implement return-to-work strategies for injured workers.
  • Reads, interprets, and applies DOT and OSHA regulations related to driver safety, occupational health, and safety.
  • Manage a team of 30 claims adjusters, ensuring that all customer inquiries were responded to in a timely manner.
  • Review and approved complex claim settlements, making sure they were within policy guidelines.
  • Monitor the performance of adjusters to ensure accuracy, timeliness and compliance with departmental standards.
  • Provide training and guidance on best practices for handling new and existing claims.
  • Develope procedures to streamline the claims process, improving overall efficiency.
  • Prepare detailed reports on claim status and activities for management review.
  • Ensure compliance with all applicable laws, regulations, policies and procedures related to claims processing.
  • Collaborate with other departments to investigate potential coverage disputes or discrepancies.
  • Negotiate settlement agreements between claimants and insurance companies when necessary.
  • Assist in developing strategies for reducing losses due to fraudulent or exaggerated claims.
  • Create processes for tracking open cases, monitoring progress towards resolution goals.
  • Maintain accurate records of all claim activities including payments, denials and appeals.
  • Implement risk mitigation measures such as quality assurance reviews of high-risk cases.
  • Participate in industry events such as conferences or seminars related to claims management.
  • Conduct regular audits of the department's performance metrics to ensure accuracy.
  • Review contracts with service providers such as attorneys or investigators for compliance purposes.
  • Traine new team members on policies and procedures for claims handling.
  • Manage team members effectively to meet high production standards with accurate results.
  • Monitor objectives to determine effectiveness of workflows, facilitating training, and mentoring for improvement.
  • Conducts meetings to discuss issues and find pertinent solutions to problems.
  • Led initiatives to enhance customer service, including the implementation of a claims hotline and online claims tracking.

Compliance Analyst

UBS Financial Services/Contract
, NJ
10.2022 - 05.2023
  • Act as an assessor in accordance with the Firm’s Violations Framework Policy
  • Establish and review facts and circumstances of potential policy and/or conduct violations identified by various groups within the firm
  • Determine level of severity of incident based on fact check and documentation
  • Enter violation and all relevant details, taxonomies, and policy breaches in Firm’s Case Management Tool
  • Ensure all appropriate documentation is retained in accordance with firm policy
  • Work in conjunction with WM Divisional team and Field management to Issue policy reminders and conduct violations as necessary

Financial Crimes Analyst

Varo Bank
, NC
11.2021 - 08.2022
  • Following established guidelines and procedures, perform routine compliance tasks and handle routine compliance issues, typically concerning documentation, reporting, etc.
  • Assisted in monitoring regulatory issues.
  • Reviewed and researched suspected items and/or transactions and report suspicious activity, as required
  • Strong investigative skills, including familiarity with public record research and database tools
  • Knowledge in AML transaction monitoring/suspicious activity reporting typologies and risks regarding funds transfers/p2p payments, and equities.
  • Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios
  • Conduct suspicious activity investigations and determine whether a Suspicious Activity Report is needed.
  • Draft narrative for each case substantiating the decision/recommendation.
  • Conduct due diligence reviews on high risk customers through analysis of customer activity compared to KYC documentation and internal/external information sources to determine if further due diligence is needed and/or change in risk disposition is warranted.
  • Identified process improvement and compliance enhancements that provided optimal internal and external customer experiences by analyzing global payment data
  • Ensured global payment processing standards were maintained and sound risk management decisions are commensurate with the Corporate and business unit’s risk appetite
  • Assists department management in assessing individual transactions that may be in violation of OFAC sanctions, rules and regulations
  • Communicate activity and trends that could be related to potential money laundering or terrorist financing to with the AML Compliance Manager
  • Apply knowledge of company policies and standard practices to resolve problems
  • Analyzes issues and use judgment to make decisions.
  • Stay apprised of regulatory matters and developments through regular review of appropriate compliance publications and websites and by participating in relevant compliance conferences and other training events.
  • Developed business process improvements for the Bank that aligns business deliverables, bank strategy and risk management framework.
  • Lead planning and execution efforts and coordinates activities for highly complex projects.
  • Applied a well-rounded understanding of risk and regulatory compliance to manage risks by using established methodologies and exercising control plans to ensure alignment with bank specific goals and process requirements.
  • Provided consultation to influence and ensure process is crafted to address risk across all activities.
  • Reviewed and develops communication and change management plans for customers and internal collaborators to drive awareness on current processes and/or changes.

Claims Examiner II

Lincoln Financial Group
04.2021 - 05.2022
  • Obtains needed increasingly complex claim information by communicating effectively with internal/external stakeholders verbally and in written form while maintaining a professional demeanor in all interactions
  • Processes increasingly complex assigned claims for payment or denial in accordance with established procedures and guidelines, in a timely manner and meeting departmental quality/production standards
  • Provides a diverse range of information and performs a diverse range of tasks/transactions related to common programs and services
  • Provides customer service to internal and/or external stakeholders, recognizes what needs to be done to meet customer needs and demonstrates flexibility and responsiveness to meet customer needs on routine work independently
  • Provides routine responses and a diverse range of information to junior team members' questions to support organizational capabilities
  • Recognizes issues or concerns for assigned area(s) of responsibility, explains effect on the customer's service experience, and suggests process improvements
  • Reviews and provides specific information to increasingly complex questions/concerns from internal/external stakeholders by applying expended knowledge
  • Reviews increasingly complex submitted claim information for payment
  • Supports and promotes change management and/or departmental/enterprise initiatives within assigned area(s) of responsibility
  • Carries out duties in compliance with all state and federal regulations and guidelines
  • Complies with all company and site policies and procedures
  • Makes a positive contribution as demonstrated by making suggestions for improvement Learning new skills, procedures and processes
  • Processed all workers compensation claims
  • Create and wrote own appeals, claims adjusting
  • Experience with Indemnity and Claims
  • Experience with worker's compensation and indemnity claims
  • Create, edit and write appeal letters
  • Adjust claims to zero balance

Financial Crimes Specialist III

Wells Fargo
01.2017 - 02.2021
  • Working all complexities and risk levels: Low, Medium and High priority cases
  • Conducting research in internal and external systems to review CIP/CDD elements
  • Analyzing submitted documentation to determine if it meets established guidelines
  • Quality Assurance (QA) Review all work for complete Accuracy
  • Ensures compliance with company and regulatory policies and procedures
  • Knowledge and understanding of regulatory compliance requirements surrounding
  • USA PATRIOT Act and Anti Money Laundering (AML) requirements
  • Strong investigative skills, including familiarity with public record research and database tools
  • Knowledge in AML transaction monitoring/suspicious activity reporting typologies and risks regarding funds transfers/p2p payments, and equities.
  • Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios
  • Monitor AML and Sanctions regulatory environment for potential changes to the AML and Sanctions Programs.
  • Conduct suspicious activity investigations and determine whether a Suspicious Activity Report is needed.
  • Draft narrative for each case substantiating the decision/recommendation.
  • Conduct due diligence reviews on high risk customers through analysis of customer activity compared to KYC documentation and internal/external information sources to determine if further due diligence is needed and/or change in risk disposition is warranted.
  • Assist with the Risk and Control Self-Assessment (“RCSA”) process and draft reports for BSA/AML Compliance Officer and senior management review.
  • Assist with coordination of the annual staffing needs assessment processes.
  • Assist with the coordination of budget monitoring and reporting for Financial Crimes Compliance Function.
  • Stays abreast of the changing regulatory landscape and updating risk appetite statement and Risk Assessment framework as necessary.
  • Identified process improvement and compliance enhancements that provided optimal internal and external customer experiences by analyzing global payment data
  • Ensured global payment processing standards were maintained and sound risk management decisions are commensurate with the Corporate and business unit’s risk appetite
  • Assists department management in assessing individual transactions that may be in violation of OFAC sanctions, rules and regulations
  • Trains team on Address Standardization, E111, Assumption Loans
  • Participates in creation and adherence to business case
  • Supports senior Program and /or Project Managers in scheduling, prioritization and 2 sequencing for work efforts.
  • Developed business process improvements for the Bank that aligns business deliverables, bank strategy and risk management framework.
  • Lead planning and execution efforts and coordinates activities for highly complex projects.
  • Applied a well-rounded understanding of risk and regulatory compliance to manage risks by using established methodologies and exercising control plans to ensure alignment with bank specific goals and process requirements.

Financial Crimes Specialist II-Claims

Wells Fargo
07.2014 - 01.2017
  • Reviews, verifies and/or identifies customer transactions to detect/prevent financial crimes activities, policy violations and suspicious situations in order to mitigate and/or recover losses
  • Monitors moderate to complex account activity which requires research that may involve multiple transaction channels
  • Uses a variety of sources for information, including online systems and tools/models
  • May perform general account handling functions such as close account determination, holds, restraints, etc
  • Document research findings and actions on cases for possible referrals for Suspicious
  • Activity, Identity Theft Operations (ITO) and Suspected Financial Abuse
  • May contact customers and/or vendors to validate transactions
  • May maintain files, records, databases and prepare standard/routine management reports
  • Prepares required documentation including Suspicious Activity Reports
  • May identify control failures in bank processes, procedures, and customer or team member decisions and then categorize losses and assign loss accountability
  • Reviews more complex/unique situations with senior department staff.

Education

Lean Six Sigma Green Belt -

Central Piedmont Community College
Charlotte, NC
12.2020

Associate of Applied Science - Criminal Justice

Iowa Central Community College
Fort Dodge, IA
10.2018

Bachelor of Science - Applied Studies, Criminal Law

University of Iowa
Iowa City, IA

Some College (No Degree) - Certified Scrum Master

Scrum Alliance
Westminster, CO
10.2022

Skills

  • Time Management
  • Verbal and written communication
  • Leadership
  • Flexibility and Adaptability
  • Critical Thinking and Problem Solving
  • Data Analysis
  • Project Management
  • Conflict Resolution
  • Skills Management
  • Collaboration
  • Computer Skills
  • Organization
  • Research
  • Active Listening
  • Attention to Detail
  • Coaching

Timeline

Supply Chain Risk & Claims Manager

Krispy Kreme
05.2023 - Current

Compliance Analyst

UBS Financial Services/Contract
10.2022 - 05.2023

Financial Crimes Analyst

Varo Bank
11.2021 - 08.2022

Claims Examiner II

Lincoln Financial Group
04.2021 - 05.2022

Financial Crimes Specialist III

Wells Fargo
01.2017 - 02.2021

Financial Crimes Specialist II-Claims

Wells Fargo
07.2014 - 01.2017

Lean Six Sigma Green Belt -

Central Piedmont Community College

Associate of Applied Science - Criminal Justice

Iowa Central Community College

Bachelor of Science - Applied Studies, Criminal Law

University of Iowa

Some College (No Degree) - Certified Scrum Master

Scrum Alliance

Similar Profiles

CREATE PROFILE
Shelitha Banks