Shquria Sumter
Summary
Results-driven insurance and claims professional with 4 years of experience in life and medical claims operations. Recognized for professionalism, strong communication, and attention to detail while managing high-volume workloads, maintaining compliance standards, and delivering accurate, dependable service in fast-paced environments.
Overview
5
5
years of professional experience
4
4
years of post-secondary education
Work History
Life Claims Analyst
Mutual of Omaha
07.2024 - Current
- Processed and review 20-30+ life insurance claims daily, ensuring accuracy, completeness, and compliance with policy guidelines and regulatory standards.
- Analyzed beneficiary documentation and policy contracts to determine claim eligibility, benefit payouts, and identify discrepancies or potential fraud indicators.
- Performed detailed document verification, data validation, and maintained accurate claim records while adhering to HIPAA and confidentiality standards.
- Collaborated with internal and external stakeholders to resolve documentation issues, expedite claim processing, and consistently exceed productivity and quality metrics.
Medical Claims Specialist
ResultsCx
Winter Haven
02.2023 - 06.2024
- Processed and reviewed medical claims with a strong focus on accuracy, compliance, and timely resolution.
- Analyzed claim documentation, EOBS, and provider submissions to verify coverage, eligibility, and payment details.
- Performed data entry, validation, and record maintenance while identifying and resolving discrepancies and incomplete information.
- Communicated with members and providers to obtain necessary documentation, resolve claim-related issues, and consistently meet productivity and quality standards in a high-volume environment.
Customer Service Representative
ResultsCX
Winter Haven
08.2021 - 08.2023
- Assisted members with billing questions, claim status updates, and provider inquiries while delivering professional customer support
- Resolved customer concerns and escalated complex issues to appropriate departments when needed
- Maintained accurate account documentation and updated customer information in company systems
- Met productivity and quality standards in a high-volume call center environment while ensuring positive customer experiences
Education
High School Diploma -
Winter Haven High School
Winter Haven, FL 08.2015 - 05.2019
Skills
- Claims Processing
- Claims Analysis
- Benefits Verification
- Documentation Review
- Regulatory & HIPAA Compliance
- Records Management
- Data Validation
- Quality Assurance
- Customer Relations
- Problem Solving
- Microsoft Office Suite (Word, Excel, Outlook)
- Time Management
- Attention to Details
- Communication Skills
Timeline
Life Claims Analyst
Mutual of Omaha
07.2024 - Current
Medical Claims Specialist
ResultsCx
02.2023 - 06.2024
Customer Service Representative
ResultsCX
08.2021 - 08.2023
High School Diploma -
Winter Haven High School
08.2015 - 05.2019