Shenise Johnson
Summary
Analytical Claims Specialist with extensive experience investigating and resolving property, health, and business claims. Provides professional customer service while meeting the needs of insured individuals, claimants, and internal and external stakeholders. Demonstrates expertise in insurance liabilities, claims practices, and superior interpersonal skills.
Overview
12
12
years of professional experience
Work History
Claim Appeal Specialist
Insight Global
02.2021 - 10.2024
- Monitored denial and appeals information for payor, provider or departmental trends that needed to be reported
- Entered denials and requests for appeal into information system and prepares documentation for further review
- Collaborated within the claims department to update policies and procedures
- Organized information by using spreadsheets, databases and word processing applications
- Worked with provider & member services to resolve balance bill issues and other member/provider complaints
- Used insurance rate standards to calculate premiums, refunds, commissions and adjustments
Assistant Coordinator
St Joseph Carmelite home
East Chicago, IN
04.2012 - 07.2021
- Assisted in the coordination of projects and activities, ensuring deadlines were met.
- Created reports summarizing project milestones, tasks, and accomplishments for residents.
- Assisted in developing processes and procedures for efficient workflows.
- Updated residents' lists with relevant information.
- Resolved residents' service issues in a timely manner, while maintaining quality standards.
Claims Representative
Aflac
08.2018 - 12.2020
- Prepared and reviewed insurance-claim forms and related documents for completeness
- Modified and updated existing policies and claims to reflect change in beneficiary, amount of coverage or type of insurance
- Exceeded department productivity standards, and reporting requirements
- Assisted the Revenue Cycle Supervisor with special projects and necessary duties
- Drafted statements of loss to summarize payments, underlying policy coverages and damages
EMPLOYER
Kemper Life Insurance
02.2017 - 07.2018
- Documented and distributed incoming claim files
- Determined liability, compensability and benefits due on each claim
- Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers
- Entered appropriate account notes in billing system to clarify actions taken to reconcile claims
- Examined claims, records and procedures to grant approval of coverage
- Checked documentation for appropriate coding, catching errors and making revisions
Education
Business Associates - Science
College of Lake County
05.2009
Skills
- Premium Collection
- Policy Coverage Review
- Microsoft Office
- Data Entry
- Teamwork and Collaboration
- Healthcare Claims (RCM)
- Utilization Review
- Case Management
- Documentation Review
- Coverage Assessments
- Settlement Determinations
- Google Suite
- Customer Service
- Paperwork Processing
- Active Listening
- Resident Records Documentation
- Physical Assessment
- Patient Monitoring
- Suicide risk assessments
- Crisis Intervention
- Critical Thinking
- Cultural Awareness
Timeline
Claim Appeal Specialist
Insight Global
02.2021 - 10.2024
Claims Representative
Aflac
08.2018 - 12.2020
EMPLOYER
Kemper Life Insurance
02.2017 - 07.2018
Assistant Coordinator
St Joseph Carmelite home
04.2012 - 07.2021
Business Associates - Science
College of Lake County