Shaniqua Marable
Claritev
Fayetteville
3
years of professional experience
Collaborated with providers, members, and internal teams to ensure precise medical claim adjudication, accurate billing, and timely resolution of healthcare claims processing issues.
Work History
Customer Resolution Specialist
4 Months- Resolved customer inquiries, billing discrepancies, and claim issues using policy guidelines and service protocols.
- Documented case activity, resolution notes, and follow-up actions in CRM and case management systems.
- Investigated escalated account concerns, researched root causes, and coordinated timely issue resolution across departments.
- Communicated clear updates on claims, appeals, and payment status to customers and internal partners.
- Prioritized inbound work queues, ensuring urgent cases received prompt attention and consistent follow-through.
- Consistently met or exceeded departmental performance metrics, contributing to the overall success of the team.
Customer Service Processor
1 Year 4 Months- Investigated and resolved insurance-related inquiries, claims discrepancies, and billing issues in a high-volume environment.
- Documented claim actions, member communications, and resolutions accurately within CRM systems.
- Resolutions.
Healthcare Provider Service Coordinator
1 Year 2 Months- Supported providers with claims processing, billing inquiries, and insurance verification.
- Researched authorization requirements, eligibility status, and provider enrollment details to resolve claim issues.
- Coordinated with cross-functional teams to resolve complex claim-related concerns efficiently.
- Maintained strict HIPAA compliance while handling sensitive member and provider information.
- Improved call efficiency and reduced wait times through streamlined communication processes.
Education
Business Administrative Certificate
Skills
Medical Claims Processing
Claims Resolution
Balance Billing
Eligibility Verification
Provider Relations
Insurance Billing
HIPAA Compliance
Medical Terminology
ICD-10/CPT Familiarity
CRM Systems
Microsoft Office
Data Analysis
Documentation Accuracy
Timeline
Customer Resolution Specialist
Claritev
04.2026 - 08.2026Read More
Customer Service Processor
Root Insurance
11.2024 - 03.2026Read More
Healthcare Provider Service Coordinator
Evolent Health
08.2023 - 10.2024Read More
Tennessee Technology Center of Applied Science
Business Administrative Certificate
Read More