Shonna Boulton
Sedgwick CMS
Brooklyn Park,MN
21
years of professional experience
Detail-oriented Claims Specialist with extensive experience in disability claims management and regulatory compliance. Skilled in assessing claims and collaborating with medical professionals to achieve optimal outcomes for clients. Proven ability to enhance operational efficiency and support individuals through effective teamwork and process improvements.
Work History
Disability Specialist
4 Years 9 Months- Managed 100-150 disability claims intake, documentation, and eligibility review using Sedgwick claims workflows.
- Interpreted medical and employer information to determine benefit continuation and return-to-work options.
- Applied FMLA, ADA, and policy guidelines to ensure compliant disability case handling.
- Reviewed medical updates and adjusted claim decisions based on evolving restrictions and recovery status.
Patient Advocate
1 Year- Coordinated patient appointments, referrals, and follow-up care across multidisciplinary teams.
- Communicated treatment plans and service updates to patients, families, and providers.
- Monitored care plans and escalated patient concerns to appropriate clinical staff.
- Trained new staff on workflow procedures, documentation standards, and patient service protocols.
Surgery Scheduling Coordinator
10 Months- Coordinated surgery schedules, balancing surgeon availability, procedure priorities, and operating room resources, for 7 physicians.
- Verified insurance authorizations and referral requirements before procedure dates to prevent delays.
- Communicated preoperative instructions, arrival times, and preparation requirements to patients and caregivers.
- Collaborated with clinical staff to confirm procedure readiness, chart completion, and documentation accuracy.
Prior Authorization Specialist
2 Years 5 Months- Reviewed prior authorization requests for medical necessity and benefit alignment
- Coordinated with providers, members, and internal teams to resolve authorization issues
- Investigated complex cases and identified coverage options within plan provisions
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
Administrative Assistant
10 Years 11 Months- Managed resident records, ensuring accurate documentation and confidential file organization.
- Coordinated daily schedules, appointments, and meeting calendars for smooth office operations.
- Answered phones, routed inquiries, and provided courteous front-desk support to families and visitors.
- Assisted billing and insurance paperwork, processing documents accurately and timely.
Education
Bachelor of Arts - Business Administration
- Dean's List 2024, 2025, 2026
- Honoree of Magna Cum Laude
- 3.8 GPA
Associate of Science - Business Administration and Management
- 3.6 GPA
Skills
Prior authorization process
Disability policy compliance
Claims management software
Insurance verification
Medical terminology expertise
Proactive problem-solving
Strong analytical skills
Attention to detail
Resource utilization
Time management
Staff onboarding
Client advocacy
Professionalism and integrity
Timeline
Disability Specialist
Sedgwick CMS
01.2022 - CurrentRead More
Patient Advocate
Accra Care
12.2020 - 12.2021Read More
Surgery Scheduling Coordinator
Colon & Rectal Surgery Associates
01.2020 - 11.2020Read More
Prior Authorization Specialist
Medica
01.2017 - 06.2019Read More
Administrative Assistant
Epiphany Assisted Living
01.2006 - 12.2016Read More
University of Arizona
Bachelor of Arts from Business Administration
Read More
Anoka-Ramsey Community College
Associate of Science from Business Administration and Management
Read More