Stanesha Boutwell
Houston,TX
Summary
Skilled Claims Supervisor with 7+ years of progressive experience in medical and auto claims, compliance, and team leadership. Proven record of managing high-performing teams, streamlining claims processes, enhancing compliance protocols, and driving operational efficiency. Adept at mentoring staff, identifying fraud trends, and optimizing workflows. Seeking a leadership opportunity in Houston to bring a customer-first mindset and data-driven approach to claims operations.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Claims Specialist Manager
F&I Sentinel
05.2024 - 09.2025
- Lead team of 15 claims specialists; oversee daily operations and ensure compliance and high-quality claims processing.
- Developed and implemented new policies cutting resolution time by 20%.
- Analyzed claims data to identify trends and implement process improvements.
- Resolved escalated disputes and partnered with legal/compliance teams.
- Collaborated with cross-functional teams to resolve customer inquiries and disputes effectively.
Claims Specialist
State Farm
09.2022 - 05.2024
- Managed a high volume of medical and auto insurance claims, ensuring timely resolution and customer satisfaction.
- Identified fraud through data analysis and investigations.
- Produced weekly metrics to optimize workflow and reduce leadership workload.
- Collaborated with underwriting and fraud teams to strengthen risk mitigation.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
Patient Service Managed Care
Boston Medical Center
08.2020 - 05.2021
- Conducted medical reviews and insurance verification.
- Oversaw daily outbound calls and patient updates.
- Verified insurance and enrollment accuracy, ensuring compliance in patient billing.
- Trained staff on claims protocols and HIPAA compliance.
- Enhanced hospital revenue cycle by identifying/correcting coverage issues.
Utilization Management Coordinator
Tufts Health Plan
11.2014 - 08.2018
- Conducted utilization reviews, insurance case management, and compliance audits.
- Drafted denial letters for non-covered cases per policy.
- Managed all member accounts securely and efficiently.
Education
Bachelor of Arts - Political Science
Georgia State University
Atlanta, GA05-2017
Skills
- Claims Management & Supervision
- Policy & Regulatory Compliance ( Epic and HIPAA)
- Fraud Detection & Risk Mitigation
- Staff Training & Development
- Salesforce (Advanced User) & Excel Analytics
- Cross-Functional Team Collaboration
- Process Optimization & Project Management
- Conflict Resolution & Customer Experience
Certification
- Salesforce Platform (Advanced User)
- HIPAA & Claims Compliance (Internal Certified)
- Microsoft Excel (Pivot Tables, Lookups, Dashboards)
Timeline
Claims Specialist Manager
F&I Sentinel
05.2024 - 09.2025
Claims Specialist
State Farm
09.2022 - 05.2024
Patient Service Managed Care
Boston Medical Center
08.2020 - 05.2021
Utilization Management Coordinator
Tufts Health Plan
11.2014 - 08.2018
Bachelor of Arts - Political Science
Georgia State University
Community Involvement
Mentor & Volunteer for Women in Technology, State Farm and Atlanta Hawks Annual Million Meal Pack Event, State Farm and Atlanta Hawks Good Neighbor Club Event
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