Shakela Barbour

Answered general health care benefit and eligibility questions for members with accuracy and compassion. Assisted members with logging into and navigating their online health account and locating provider information.

Thoroughly reviewed medical records to determine whether internal guidelines and coverage requirements were met. Drafted comprehensive letters of medical necessity based on clinical findings from office notes and medical history.

Collaborated with internal departments to ensure timely review and approval or denial of clinical documentation. Participated in biweekly triage meetings to discuss complex clinical cases with cross-functional team members.

Recommended health plan upgrades based on strong product knowledge and member needs. Responded to inbound calls regarding health plan benefits, coverage details, and account questions.

Utilized Google Suite, Adobe, and Salesforce CRM to manage documentation workflows and case tracking. Worked independently to prioritize and meet required deadlines across a high volume of clinical case reviews.

Supported members with general inquiries related to health plan benefits, enrollment, and eligibility. Located and shared accurate doctor and facility information to help members access needed care.

Pursuing an Associate of Science in Health Management, with an expected completion in April 2026.