SHIRIKA SUAZO
Queen Creek,AZ
Summary
Experienced Claims Professional with 10 years in investigating and resolving complex insurance claims, including auto and bodily injury. Processed high volumes of claims while ensuring accuracy and compliance. Collaborated with stakeholders to resolve disputes and improve revenue cycle efficiency.
Overview
7
7
years of post-secondary education
10
10
years of professional experience
Work History
Revenue Cycle Specialist
Banner Health
Mesa
10.2024 - Current
- Process high-volume medical claims, ensuring accuracy and compliance with industry regulations.
- Investigated claim discrepancies and resolved issues with insurance carriers, ensuring accurate processing.
- Streamline existing workflows to reduce claim denials and enhance overall revenue cycle efficiency.
- Collaborated with healthcare providers and patients to resolve billing concerns, enhancing patient satisfaction.
- Maintained meticulous documentation and comprehensive case records to support efficient claims management.
Injury Adjuster (Independent Contract)
The Hartford
Phoenix
11.2023 - 10.2024
- Investigated complex claims, determined liability with precision, and evaluated damages comprehensively.
- Established accurate financial reserves, managing claims to achieve favorable resolutions.
- Negotiated equitable settlements with attorneys and claimants, securing favorable outcomes for all parties.
- Managed a diverse caseload of commercial and bodily injury claims with meticulous attention.
- Drafted comprehensive reports outlining findings from investigations into claims involving personal injury or property damage.
- Negotiated and settled claims according to information presented through reports, research, and data verification.
- Assisted attorneys with preparation for mediations and arbitrations by providing necessary evidence and arguments.
Claims Adjuster (Auto & Bodily Injury)
State Farm
Tempe
08.2021 - 10.2023
- Investigated auto accidents, meticulously determining fault and liability.
- Compiled and analyzed police reports, medical records, and damage estimates to develop thorough case files.
- Negotiated settlements to resolve claims promptly and processed payments to expedite claimant satisfaction.
- Reviewed medical records, police reports and other documents related to claim investigations.
- Oversaw claims from initial report to final closure, addressing all details to ensure comprehensive resolution.
- Negotiated fair settlements and processed claim payments efficiently.
- Negotiated settlements with claimants or their representatives in order to resolve disputes quickly and economically.
- Worked collaboratively with team members across multiple departments; identified areas where processes could be improved.
- Analyzed facts of loss including photographs, diagrams and other evidence to identify potential sources of recovery.
Claims Specialist / Team Lead
Junk Haul Removal LLC
Tempe
07.2020 - 04.2022
- Processed 80 claims weekly while handling high volume of customer calls, ensuring timely resolutions.
- Evaluated reports, statements, and supporting documentation to substantiate claims.
- Trained new team members on claims processing systems and created onboarding materials to facilitate smooth transitions.
- Investigated claims by interviewing policyholders and inspecting properties.
- Collaborated with contractors to evaluate repair costs and determine necessary work, enhancing claim accuracy.
- Assessed repair costs by collaborating with contractors to evaluate project needs.
- Communicated findings to clients and provided clear claim decisions.
Human Resource Analyst
Maricopa Community District Colleges
Tempe, Arizona
08.2019 - 07.2020
- Resolved complex payroll issues related to absence management and benefit payments, ensuring accurate employee compensation and compliance.
- Coordinated and administered job classification and compensation programs to align workforce capabilities with organizational goals.
- Acted as the EPO subject matter expert for Class/Comp system updates and led compensation-focused tasks during the fiscal year-end close.
- Directed payroll and HCM functions and processes for a college, ensuring compliance with policies and procedures.
- Resolved complex payroll issues connected to absence management and benefit payments.
- Liaised with internal and external stakeholders to meet program requirements, fostering collaboration and maintaining professional representation.
- Authored comprehensive reports, presentations, correspondence, and program documentation.
Medical Claims Officer
Memorial Hermann
Houston
03.2016 - 04.2019
- Reviewed and processed medical claims, ensuring accurate verification of insurance coverage details to facilitate timely reimbursements.
- Processed medical claims using advanced billing software and electronic filing systems.
- Investigated claim details to determine appropriate payment or denial.
- Reviewed claims for accuracy before submitting for billing.
- Collaborated with healthcare providers to effectively resolve claim discrepancies, enhancing accuracy of billing and payment processes.
- Investigated discrepancies in medical billing information such as incorrect codes or amounts due.
- Verified accuracy of provider data entered into the system including tax ID numbers, NPI numbers, address changes.
- Trained new staff on claims processing procedures and company policies.
- Investigated discrepancies in medical billing information, identifying and correcting incorrect codes or amounts due to maintain compliance and reduce claim rejections.
Education
Associate of Arts - Business Management
Columbia College
Jacksonville, FL 08.2010 - 10.2012
Associate of Applied Science - Information And Computer Systems
Penn Foster Career School
Scranton, PA 08.1994 - 08.1999
Bachelor's - Psychology & Theology
South Florida Bible College
Deerfield Beach, FLSkills
- Claims Processing
- Medical Claims Officer
- Auto & Bodily Injury Claims
- Liability Claims
- Commercial Auto Claims
- Claims Negotiation & Settlement
- Liability Investigation
- Claim Handling
- Claim investigation
- Claims analysis
- Insurance Coverage Knowledge
- Healthcare Compliance
- Insurance Billing management
- Settlement agreements
- Insurance assessment
- Subrogation awareness
- Workflow management
- Data interpretation
- Analytical skills
- Interpersonal communication
- Negotiation tactics
- Patient Engagement
- Claim investigation
Timeline
Revenue Cycle Specialist
Banner Health
10.2024 - Current
Injury Adjuster (Independent Contract)
The Hartford
11.2023 - 10.2024
Claims Adjuster (Auto & Bodily Injury)
State Farm
08.2021 - 10.2023
Claims Specialist / Team Lead
Junk Haul Removal LLC
07.2020 - 04.2022
Human Resource Analyst
Maricopa Community District Colleges
08.2019 - 07.2020
Medical Claims Officer
Memorial Hermann
03.2016 - 04.2019
Associate of Arts - Business Management
Columbia College
08.2010 - 10.2012
Associate of Applied Science - Information And Computer Systems
Penn Foster Career School
08.1994 - 08.1999
Bachelor's - Psychology & Theology
South Florida Bible College