SHUNTANG D. CARSON
Smyrna,DE
Summary
Healthcare operations professional transitioning to Actuarial Science, combining 5+ years of experience in Medicaid managed care environments, patient data management, and regulatory compliance. Committed to applying rigorous data governance and analytical precision to capitation rate development and risk adjustment. Actively pursuing FSA designation to deepen expertise in organizational capabilities and financial modeling. Core Actuarial & Data Competencies
Overview
6
6
years of professional experience
Work History
Remote Customer Service Representative
TTEC
Greenwood Village, CO
10.2025 - Current
- Data Quality & Documentation: Maintain high-quality documentation of customer interactions in CRM systems, ensuring data definitions align with service standards and creating a reliable audit trail.
- Issue Resolution: Analyze complex billing and account disputes to determine root causes and suggest resolutions of moderate complexity, preventing escalation.
- Process Improvement: Collect and document customer feedback data to support service improvement initiatives, identifying trends in service disruptions.
- Compliance: Process sensitive transactions (payments, account updates) while adhering to strict data security and privacy protocols.
Medical Referral Clerk
PQC International
Dover, DE
11.2022 - 02.2025
- Medicaid Market Analysis: Verified patient eligibility and insurance benefits across different Medicaid markets and commercial plans, ensuring accurate authorization for specialty care.
- Data Management: Managed and updated electronic medical records (EMR), performing regular assessments on data assets to ensure accuracy, compliance, and receipt of external records.
- Provider Collaboration: Communicated effectively with providers and external medical facilities, serving as a liaison to ensure seamless data transfer and continuity of care.
- Workflow Optimization: Requested and tracked medical records, organizing unstructured data into actionable files for clinical review.
Recovery Support Specialist
Recovery Centers of America
Earleville, MD
10.2019 - 10.2022
- Regulatory Compliance: Maintained strict confidentiality and compliance with healthcare regulations (HIPAA, 42 CFR Part 2), ensuring data security for sensitive patient populations.
- Operational Reporting: Completed detailed shift documentation and monitored patient safety/compliance, providing critical data points for clinical team assessments.
- Cross-Functional Teamwork: Partnered with clinical teams to facilitate treatment programs, bridging the gap between direct care operations and administrative documentation requirements.
Education
GED - Country
School or training provider
Associate's degree - PSYCHOLOGY
POST UNIVERSITY
Waterbury, CTBachelor of - Criminology
University of Phoenix
Skills
- Excel (Advanced)
- SQL
- Data Governance Principles
- Medical Terminology
- EMR Systems
Timeline
Remote Customer Service Representative
TTEC
10.2025 - Current
Medical Referral Clerk
PQC International
11.2022 - 02.2025
Recovery Support Specialist
Recovery Centers of America
10.2019 - 10.2022
Associate's degree - PSYCHOLOGY
POST UNIVERSITY
Bachelor of - Criminology
University of Phoenix
GED - Country
School or training provider
Asset Assessment
Perform assessments on data assets and suggest resolutions of moderate complexity; maintain high-quality documentation of data definitions, transformations, and processes.
Reporting & Communication
Prepare information for actuarial and non-actuarial audiences by building reports and delivering summaries of results; collaborate effectively with broader healthcare analytics teams.
Strategic Analysis
Analyze different data sources to determine value and make recommendations; assess how organizational capabilities interrelate across the function or segment.
Data Governance
Incorporate core data management competencies, including data security, data quality, and governance protocols to ensure integrity in financial reporting.