Shonti Moore
Lexington,SC
Summary
Dedicated and focused claims collector, administrative assistant, youth counselor, and customer service advocate. Excels at prioritizing and completing multiple tasks simultaneously, ensuring successful project outcomes. Strong commitment to follow through and consistently achieve project goals. Seeking a role of increased responsibility to expand knowledge of the company.
Overview
8
8
years of professional experience
Work History
Intake Coordinator/ UM Coordinator
Brighton Health Plan Solutions
04.2024 - 01.2025
- Answer incoming calls from providers with questions regarding prior authorizations and member’s benefits
- Performs research as needed to resolve inquiries
- Provide exceptional customer service
- Respond to emails and phone calls, and preparing and distributing correspondences
- Responding for helping successful completion of incoming prior authorizations request via fax
Patient Care Advocate
Cigna Healthcare- Express-Scripts
10.2023 - 04.2024
- Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures.
- Answer Incoming Calls from Members and Providers with questions regarding their health benefits.
- Performs research as needed to resolve inquiries.
- Reviews and adjudicates claims and/or non-medical appeals.
- Determines whether to return, deny or pay claims following organizational policies and procedures.
Client Service Representative
Blue Cross and Blue Shield of South Carolina-Medicare Advantage
05.2022 - 09.2023
- Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures.
- Answer Incoming Calls from Members and Providers with questions regarding their health benefits.
- Performs research as needed to resolve inquiries.
- Reviews and adjudicates claims and/or non-medical appeals.
- Determines whether to return, deny or pay claims following organizational policies and procedures.
Case Manager
Gusto
Remote
10.2021 - 10.2022
Managed health benefits operations at Gusto, ensuring precise administration and delightful customer experience.
• Collaborated with team members on special projects to increase efficiency and scale operations.
• Communicated with health insurance carriers to confirm proper coverage and implement employee benefits packages.
Data Prep Technician I
Blue Cross and Blue Shield
Columbia, SC
08.2016 - 03.2022
- Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures.
- Answer Incoming Calls from Members and Providers with questions regarding their health benefits.
- Performs research as needed to resolve inquiries.
- Reviews and adjudicates claims and/or non-medical appeals.
- Determines whether to return, deny or pay claims following organizational policies and procedures.
Education
BACHELOR OF SCIENCE - EXPERIMENTAL PSYCHOLOGY
University of South Carolina
Spartanburg, SC05.2011
Skills
- Customer Service
- Databases
- Case Management
- Individual Counseling
- Group Counseling
- Medical Terminology
- Behavioral Therapy
- Microsoft Access
- DME
- ICD-10
- ICD-9
- Managed care
- Administrative Assistant
- Good communication skills
- Counseling clients
- Experiment
- Fax
- Filing
- Insurance claims
- Mental health
- Mentoring
- Excel
- Microsoft Office software
- Office
- PowerPoint
- Word
- Psychology
- Research
- Supervisor
- Patient care
- Organizational skills
- HIPAA compliance
- Patient education
- Claims processing
- Client documentation
- Documentation
- Goal setting
- Appointment scheduling
- Follow-up care
- Quality assurance
- Strategic planning
Additional Information
Proficient in the following areas: Administrative Assistant, Good communication skills, Counseling clients, Customer Service, databases, experiment, fax, filing, insurance claims, medical terminology, mental health, mentoring, Excel, Microsoft Office software, Office, PowerPoint, Word, Psychology, Research, Supervisor
Personal Information
- Willing To Relocate: Anywhere
- Authorized To Work: US for any employer
Timeline
Intake Coordinator/ UM Coordinator
Brighton Health Plan Solutions
04.2024 - 01.2025
Patient Care Advocate
Cigna Healthcare- Express-Scripts
10.2023 - 04.2024
Client Service Representative
Blue Cross and Blue Shield of South Carolina-Medicare Advantage
05.2022 - 09.2023
Case Manager
Gusto
10.2021 - 10.2022
Data Prep Technician I
Blue Cross and Blue Shield
08.2016 - 03.2022
BACHELOR OF SCIENCE - EXPERIMENTAL PSYCHOLOGY
University of South Carolina