Shonda Byron
Bureau of Workers' Compensation - State Of Ohio
Columbus,OH
10
years of professional experience
Detail-oriented Claims Specialist experienced in analyzing and processing diverse claims. Expert in investigative techniques, compliance with industry regulations, and providing exceptional customer service. Proven success in resolving complex claims and identifying discrepancies to deliver fair settlements. Collaborative team player focused on results and adaptable to changing requirements.
Work History
WC Claims Specialist
1 Year 1 Month- Analyzed complex cases to determine eligibility and recommend appropriate benefits.
- Maintained comprehensive records of all claims activity to ensure transparency and accountability.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting claim details.
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Analyzed claim documents to ensure accuracy and compliance, mitigating risk of financial loss.
Customer Service Representative I
3 Years 1 Month- Resolved patient inquiries related to claims, payment options, and financial assistance, maintaining a 95% average satisfaction score.
- Efficiently de-escalated 85% of high-tension calls, ensuring positive resolutions and patient retention.
- Updated and maintained over 10,000 patient records for accuracy and confidentiality.
- Contributed to 15% reduction in claim processing time through proactive follow-ups and data accuracy.
- Guided patients on payment plans and financial assistance to enhance access to healthcare.
Senior Specialist I
4 Years 6 Months- Investigated and resolved over 1,500 financial fraud claims annually, achieving a 97% resolution rate.
- Contributed to team achieving 2nd in department performance while maintaining personal KPI of 95%+.
- Created customer-focused solutions that led to 10% increase in overall satisfaction scores.
- Earned recognition from leadership for exceptional service delivery in high-pressure situations.
Education
Bachelor of Arts - Criminal Justice
- Dean’s List: 2020-2022 and 2024-2026
- Magna Cum Laude
- Member, National Society of Leadership and Success
- Member, National Society of Order of the Sword & Shield Omicron Sigma Sigma
- GPA: 3.7
Skills
Claims investigation
Document analysis
Regulatory compliance adherence
Information verification
Analytical thinking
Critical thinking
Problem-solving
Time management
Written communication
Active listening
Timeline
WC Claims Specialist
Bureau of Workers' Compensation - State Of Ohio
07.2025 - CurrentRead More
Customer Service Representative I
Trinity Health
07.2021 - 08.2024Read More
Senior Specialist I
JPMorgan Chase
01.2017 - 07.2021Read More
University of Phoenix
Bachelor of Arts from Criminal Justice
Read More