Tykayla Shepherd

• Reviewed and processed a high volume of health, disability, and workers’ compensation claims with precision and adherence to policy.
• Verified benefits eligibility and ensured compliance with plan provisions and organizational guidelines.
• Investigated and resolved complex claim discrepancies, appeals, and disputes while maintaining service level expectations.
• Applied knowledge of regulations including HIPAA, ERISA, and ACA to ensure full compliance throughout the claims lifecycle.
• Leveraged claims management platforms such as Workday, ADP, and PeopleSoft to document, track, and report claim activity.
• Collaborated cross-functionally with HR, providers, and external vendors to streamline claims resolution and improve customer satisfaction.

• Maintained accurate and confidential claim records in strict compliance with company policies and regulatory standards.

• Managed a high-volume caseload while ensuring timely, accurate, and efficient claims processing.

• Performed quality control audits to identify discrepancies, minimize errors, and enhance operational efficiency.

• Investigated potential fraud and escalated findings to compliance and risk management teams for further action.

• Assisted in onboarding and training new hires on claims processing procedures, system navigation, and compliance best practices.
• Collaborated with underwriters, adjusters, and legal teams to resolve complex or escalated claims efficiently.
• Generated and analyzed reports on claims trends, processing performance, and regulatory compliance for internal review.
• Ensured accurate and timely reimbursements to policyholders, providers, and third-party entities, maintaining a high standard of customer service.