Cherika Shelton

Manage the claims process from initiation through settlement, ensuring compliance with policy terms and regulations.
Communicate with insured individuals via phone, email, and text to gather statements and documentation.
Review and investigate claims using photos and submitted documents; complete estimates via Xactimate.
Assess damage and negotiate settlements.

Responsible for timely and compliant claim submission to third-party payors across multiple specialties and facilities.

Follow up on outstanding insurance accounts receivable to reduce days in AR and ensure accurate reimbursement.

Resolve rejections, denials, and non-payment issues, initiating appeals when necessary.

Identify patterns and trends in denials and delays to expedite future resolutions and optimize billing processes.

Review and respond to patient and insurance correspondence regarding billing inquiries or payment discrepancies.

Reviewed EOBs to verify correct payment and identify underpayments.

Contacted insurance companies and patients to resolve payment delays and discrepancies.

Ensured claims were processed according to payer guidelines and escalated unresolved issues.

Supported month-end reconciliation and reporting to revenue cycle managers.

Evaluated liability claims to determine coverage and settlement options.

Collaborated with legal teams to gather evidence and support claim resolutions.

Reviewed policy documentation to ensure accuracy in claims processing.

Conducted investigations into claims to identify fraud or inconsistencies.

Conducted early settlement negotiations on bodily injury claims