Sultan Shareef
Anaheim,CA
Summary
Detail-oriented Claims Processor with a track record of accurately evaluating and resolving insurance claims. Skilled in documentation review, ensuring compliance, and communication with clients and teams. Effectively manages high-volume workloads while ensuring reliability and accuracy.
Overview
14
14
years of professional experience
Work History
Claims Processor II (Contractor)
Inland Empire Health Plan (IEHP)
Rancho Cucamonga, CA
06.2025 - 01.2026
- Processed 50+ claims daily for lab, radiology, ambulance, behavioral health, and vision services with 98% accuracy.
- Applied 100% of claims using IEHP, Medi-Cal and Medicare regulations to ensure 100% correct payment or denial.
- Resolved 20+ claim discrepancies weekly, including denials and COB issues, consistently meeting 3-day turnaround times.
- Reviewed claims for coding accuracy, authorization, eligibility, and benefit coverage.
Claim Analyst (Contractor)
Centene Corporation
Rancho Cordova, CA
11.2023 - 04.2025
- Adjudicated 500+ professional and institutional claims per week while maintaining 98–100% quality scores.
- Identified and corrected claim discrepancies, reducing rework and denials by 20%.
- Resolved 50+ claim issues weekly through detailed analysis and policy interpretation.
- Communicated with 100+ providers and members monthly to resolve claim-related issues.
- Consistently exceeded productivity and quality targets in a high-volume claims environment.
Claims Audit Representative
California Employment Development Department
Sacramento, CA
12.2022 - 07.2023
- Investigated 20–30 unemployment claims per week, ensuring compliance with state regulations.
- Verified claim accuracy by conducting 10-15 weekly interviews with claimant and employers, preventing overpayments.
- Responded to 70+ claimant inquiries weekly, resolving 70–80% of cases within seven days.
- Verified claimant and employer information across multiple EDD systems to ensure accuracy and regulatory compliance.
- Managed and de-escalated 100+ high-stress client interactions monthly.
Claims Processor I
Carelon Behavioral Health
Cypress, CA
05.2015 - 08.2020
- Processed 150–200+ CMS-1500 and UB-04 claims daily, maintaining productivity and accuracy in a high volume environment.
- Maintained 98–99% data entry accuracy, improving processing efficiency and reducing rework.
- Reviewed claims for completeness, coding accuracy, and policy compliance prior to adjudication.
- Identified and resolved 20-30 claim discrepancies daily correcting system errors to ensure accurate and timely payments.
- Met 100% of daily and monthly production quotas consistently in a high-volume claims environment.
Administrative Assistant
Spafax
Orange, CA
10.2013 - 03.2015
- Managed calendars and schedules for a 10+ creative/media team, coordinating 50+ meetings monthly across multiple time zones.
- Coordinated 50–70 in-flight media assets per month (films, TV shows, promotional content), ensuring timely delivery and client satisfaction.
- Managed digital media libraries of 100+ files, improving retrieval speed for by 50%.
- Maintained 100% compliance by auditing content weekly with 20-30 distributors and airline clients.
Medical Data Entry Specialist (Contractor)
Kaiser Permanente
Downey, CA
10.2011 - 05.2012
- Processed and maintained up to 200 patient and operational records daily in EHR and internal databases.
- Verified and reconciled data, ensuring near 100% HIPAA compliance.
- Maintained and updated electronic patient records, achieving 98–99% accuracy while ensuring full HIPAA compliance.
- Prepared and validated data for reports, reducing errors by 15%.
- Collaborated with internal teams to resolve discrepancies, cutting correction time by 20%.
- Streamlined data entry and administrative processes using Microsoft Office and healthcare software.
Education
General Education/High School Diploma -
Savanna High School
Anaheim, CABusiness Administration
DeVry University
Long Beach, CAComputer Science
Fullerton College
Fullerton, CASkills
- Claims Processing & Adjudication
- Data Entry/50WPM
- Microsoft Office (Word, Excel, Outlook)
- Medical Terminology & Coding Knowledge
- Member & Provider Communication
- Organization & Time Management
Timeline
Claims Processor II (Contractor)
Inland Empire Health Plan (IEHP)
06.2025 - 01.2026
Claim Analyst (Contractor)
Centene Corporation
11.2023 - 04.2025
Claims Audit Representative
California Employment Development Department
12.2022 - 07.2023
Claims Processor I
Carelon Behavioral Health
05.2015 - 08.2020
Administrative Assistant
Spafax
10.2013 - 03.2015
Medical Data Entry Specialist (Contractor)
Kaiser Permanente
10.2011 - 05.2012
Business Administration
DeVry University
Computer Science
Fullerton College
General Education/High School Diploma -
Savanna High School