Shelondia Winston
Pembroke Township,IL
Summary
Proactive and versatile professional with a dedication to quickly adapting to new challenges. Strong problem-solving abilities and a proven track record of fostering strong relationships with clients and team members. Focused on supporting team success and achieving positive results.
Overview
24
24
years of professional experience
Work History
Business Analysis Lead Analyst
THE CIGNA GROUP
01.2020 - 01.2025
- Provided auditing feedback by utilizing SOP's, checklists, and job aids to validated accuracy activities and proper handling per Cigna's guidelines.
- Participated in huddle meetings, team meetings, and training sessions.
- Provided technical support to Business Operations for their applications.
- Acted as a champion with IT team to ensure Business Operations needs are resolved.
- Researched and reviewed claim issues, working with coaches and any other clients/third party vendors as needed.
- Provided 1st level ticket triage/resolution, including application crisis management, communication and reporting
Quality Review and Audit Lead Representative Contract Sr Associate
THE CIGNA GROUP
01.2015 - 01.2020
- Oversaw internal Business communication of issues defined as high/critical business impact across IT and business from initial communication thru to resolution.
- Resolved complex inquires received from customers using independent judgement ensuring client satisfaction.
- Supported projects such as Problem Referral, Intake Analysis, and Innovation Project, or any other project as needed.
Financial Recovery Specialist
THE CIGNA GROUP
01.2012 - 01.2015
- Supported Business with external communication via talking points and client letters.
- Performed root cause analysis on claim issues and solve problems to completion.
- Performed research analysis to determine root cause and resolution on issues impacting customers.
- Updated Managers on any identified trends or client interaction that should be escalated or communicated.
- Trained new team members.
Appeals Processor Sr Associate
THE CIGNA GROUP
01.2010 - 01.2012
- Worked with Small, Regional, and National accounts to understand how claim payment affects the result of provider and customer satisfaction.
- Managed escalated issues received through appropriate workflow tools.
- Review incoming appeals from customer and health care professionals.
- Research particular item being appealed against Standard Operating Claim Payment Procedures.
- Make adjustments on overturned appeals or send formal letter explaining appeals that are upheld.
Correspondence Processor Sr Associate
THE CIGNA GROUP
01.2007 - 01.2010
- Investigated and understood the elements of provider contracts to accurately convey provider data in Cigna claim and claim payments systems.
- Reviews and completes required adjustments, including steps necessary for adjudication.
- Receives and handles 'real time' adjustments requests from the Same Day Adjustment Model (Call) by working directly with the Customer Service Advocates (CSAs).
- Settles claims with claimants in accordance with policy provisions. Compares claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim.
- Independently review complex or specialty claims, identifies trends and provides feedback to reduce errors in claim processing.
Claims Processor Sr Associate
THE CIGNA GROUP
01.2004 - 01.2007
- Participated in the outreach program, reaching out to customers/providers for additional information.
- Gained an understanding of HSA/HRA/FSA/HDHP.
- Reviews and completes required adjustments, including steps necessary for adjudication within 48 hours.
- Determines insured eligibility by analyzing contract and claim information.
- Responds to service-related issues and concerns within required time frames to meet customer expectations. Keep internal and external business partners up to date.
- Completes special projects accurately and within established timeframes and excellent follow through to ensure issues are completed.
Accounts Payable Specialist
BAKER & TAYLOR
01.2001 - 01.2004
- Reviewed, coded, and matched invoices for payment processing.
- Reconciled vendor statements and addressed discrepancies.
- Managed vendor inquiries and resolved payment issues, preparing invoices for check runs.
Skills
- Cross-Functional Collaboration
- Written and Verbal Communication
- Vista
- Benefit Access
- CPF
- Xnet
- Iview
- Itrack
- Epro
- SANP
- CFunds
- CED
- Third Party Vendor Management
- Eligibility
- Structure
- Contingency Plans
- HSA/HRA/FSA/HDHP
- HIPPA
- Data analysis
- Process improvement
- Root cause analysis
- Technical support
- Client communication
- Regulatory compliance
- Application troubleshooting
- Trend identification
- Problem solving
- Crisis management
- Trend analysis
Timeline
Business Analysis Lead Analyst
THE CIGNA GROUP
01.2020 - 01.2025
Quality Review and Audit Lead Representative Contract Sr Associate
THE CIGNA GROUP
01.2015 - 01.2020
Financial Recovery Specialist
THE CIGNA GROUP
01.2012 - 01.2015
Appeals Processor Sr Associate
THE CIGNA GROUP
01.2010 - 01.2012
Correspondence Processor Sr Associate
THE CIGNA GROUP
01.2007 - 01.2010
Claims Processor Sr Associate
THE CIGNA GROUP
01.2004 - 01.2007
Accounts Payable Specialist
BAKER & TAYLOR
01.2001 - 01.2004
Similar Profiles
Jerece DennisJerece Dennis
Provider Service Representative at The Cigna GroupProvider Service Representative at The Cigna Group
Ellie PolackEllie Polack
Managing Director at The Cigna GroupManaging Director at The Cigna Group
Christopher M. StewartChristopher M. Stewart
Risk Management and Underwriting LDP at The Cigna GroupRisk Management and Underwriting LDP at The Cigna Group
Diandra Hippolyte McKnightDiandra Hippolyte McKnight
Supplemental Health Benefits Specialist at The Cigna GroupSupplemental Health Benefits Specialist at The Cigna Group
Leonard FairrowLeonard Fairrow
Driver at Pinnacle Fleet TransportDriver at Pinnacle Fleet Transport