shark vr
@sharkvr
Experienced healthcare specialist focusing on claims, operations, and process improvement.
United StatesWhat I'm looking for
I am an experienced and results-driven healthcare specialist with 4+ years in healthcare customer service and insurance, including Medicaid and commercial claims processing. I have consistently maintained quality scores above 98.5% (PA) and 99.75% (FA), and have functioned as a subject-matter expert providing coaching, escalations support, and complex claim adjudication.
I excel at claims processing, prior authorization, pharmacy support, EMR/EHR data entry, and non-phone roles such as chat and ticketing. I bring strong organizational, multitasking, and communication skills, familiarity with CPT, ICD-9/10, HCPCS, and experience using Epic and Cerner, Windows applications, and dual-monitor workflows.
Experience
Work history, roles, and key accomplishments
Technical Support Specialist
Concentrix
Jan 2025 - Present (1 year 5 months)
Provided empathetic technical support for Apple hardware and software via phone and chat, educating users and resolving issues to improve customer satisfaction in technical support roles.
Medical Claims Examiner
NTT Data
Jan 2024 - Dec 2025 (1 year 11 months)
Reviewed and adjudicated professional claims per client-defined workflows, maintained high quality scores, and ensured timely resolution of email-priority claims while following confidentiality protocols.
Healthcare Operations Specialist
eHealthInsurance
Jan 2024 - Dec 2025 (1 year 11 months)
Processed professional claim forms, reviewed policies and benefits, and ensured HIPAA compliance while meeting turnaround timelines and quality targets above 98%. Improved adjudication accuracy by applying fee schedules and client workflows.
Senior Claims Benefits Specialist
ElevanceHealth
Jan 2022 - Dec 2024 (2 years 11 months)
Reviewed and adjudicated complex Medicaid claims, served as SME providing coaching on escalations, and implemented cost-containment measures while ensuring regulatory compliance and accurate payments.
Insurance Verification Specialist
Humana
Jan 2020 - Dec 2022 (2 years 11 months)
Managed insurance verification and payer processing for Medicaid and commercial claims, supported pharmacy and case management, and maintained HIPAA-compliant documentation in EMR/EHR systems.
Education
Degrees, certifications, and relevant coursework
Walden University
Bachelor of Business Management, Business Management
Grade: 3.8 / 4.0
Bachelor of Business Management with a GPA of 3.8/4.0.
Availability
Location
United StatesAuthorized to work in
Job categories
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