Shewanna Mason
Florence,USA
Summary
Dedicated professional with demonstrated strengths in customer service, time management and trend tracking. Good at troubleshooting problems and building successful solutions. Excellent verbal and written communicator with strong background cultivating positive relationships and exceeding goals.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Sr. Quality Assurance Analyst
Blue Cross Blue Shield of South Carolina
2024.12 - Current
- Conduct focused quality audits across operations functions to ensure adherence to quality standards, procedures, and methodologies.
- Document audit findings, prepare recommendations for new systems, procedures, or organizational changes to reduce errors.
- Identify areas of weakness and communicate improvement recommendations to training materials.
- Provide feedback to management on errors detected, ensuring resolution and long-term fixes.
- Develop and implement a quality control and improvement program based on audit targets.
- Monitor and evaluate the implementation of corrective action plans.
- Compile data, generate reports, and provide feedback on quality performance for operations and training.
- Train new employees and stay current with guideline changes and work instructions.
- Write or assist in writing desk procedures and training materials.
- Support special projects such as testing new business implementations, reviewing change requests, interpreting workload/statistical reports, and assisting colleagues.
Career Coach
EmployReward Solutions (ERS)
2021.07 - Current
- Maintained current databases of participant and program information in electronic records system.
- Guided participants through development of personalized career plans.
- Improved outcomes by encouraging clients to fully utilize available workshops and other resources.
- Reinforced use of skills learned in orientation activities through regular client meetings and ongoing coaching sessions.
- Identified short- and long-term goals and helped clients strategize ways to accomplish objectives.
- Research new employment opportunities and help clients strategize for a successful job interview.
- Perform various services to ensure client success (i.e., mock interviews, education assistance, and career counseling).
Claims Customer Service Advocate II/Appeals Specialist
Blue Cross Blue Shield of South Carolina
2013.02 - 2021.06
- Providing customer service to medical providers and patients by identifying incorrectly processed claims by completing adjustments and other reprocessing actions.
- Respond to routine correspondence and telephone inquiries pertaining to claims or appeals.
- Performs non-medical reviews and process redetermination letters ensuring timeliness and accuracy.
- Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools.
- Update letters and documents within the department when necessary.
- Gather and prepare documentation for legal inquires and administrative requests.
Education
Associate of Science - Medical Billing And Coding
Ultimate Medical Academy
Tampa, FL2025-10
Skills
- Efficient documentation management
- Conflict resolution
- Coverage determination
- Detailed case documentation
- Effective communication
- Team leadership
- Experience in quality assurance
- Analytical thinking skills
- Detailed audit documentation
Certification
- Customer Service Phone Skills Certification
- Notary for the State of South Carolina
Timeline
Sr. Quality Assurance Analyst
Blue Cross Blue Shield of South Carolina
2024.12 - Current
Career Coach
EmployReward Solutions (ERS)
2021.07 - Current
Claims Customer Service Advocate II/Appeals Specialist
Blue Cross Blue Shield of South Carolina
2013.02 - 2021.06
Associate of Science - Medical Billing And Coding
Ultimate Medical Academy