Overview
Work History
Education
Skills
Timeline
Generic

ShaToya Johnson

Raytown,MO

Overview

17
17
years of professional experience

Work History

Claims Specialist

State Farm
11.2022 - Current
  • Investigating, evaluating, and resolving claims
  • Applying knowledge of policies and insurance regulations when determining coverage and damages
  • Contacting customers by telephone, written correspondence and/or variously electronic media
  • Prioritizing task and assisting with other claims when needed
  • Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
  • Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.

Prior Authorization Representative

Aetna
11.2018 - 11.2022
  • Supported coordination of medical services including screening, referrals, and intakes
  • Maintained accurate documentation of required information that meets regulatory and accreditation requirements
  • Provided necessary information to members and providers regarding services via phone, fax and EDI
  • Approve medical services that do not require medical review in accordance with the benefit plan
  • Utilize eTUMS and other Aetna systems to compile, research and enter members information such as eligibility/benefits verification and COBs
  • Promotes effective communication between medical personnel internally and externally
  • Obtain authorizations for approvals under the direction of medical management

Customer Care Rep

Anthem
09.2016 - 10.2018
  • Responded to internal and external customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims
  • Operated a PC/image station to obtain and extract information; documents information, activities and changes in the database
  • Thoroughly documents inquiry for accurate tracking and analysis
  • Maintained positive customer relations and coordinates within the company to ensure customer requests and questions are handled appropriately and in an timely manner
  • Provided external and internal customers with requested information
  • Under immediate supervision, received and placed follow-up telephone calls / e-mails to answer customer questions that are routine in nature

Service Advisor

US Bank
03.2013 - 08.2016
  • Reviewed information given by clients of customers with overdue accounts
  • Placed phone calls, sent invoices, or emailed customers to remind them of account contracts, payments, due dates, and amount owed
  • Attempted to collect debt for past due credit cards and bring current
  • Performed collection activities in accordance with state and local collections laws in an effort to recover unpaid debt

Warehouse Associate

Cardinal Health
02.2008 - 02.2013
  • Proficient in use of pallet movers, standup forklifts
  • Accurately label freight, monitor inventory, and verify quantities using computers to maintain records
  • Track shipments within high-volume warehouse environments
  • Performed day to day functions of Loading and unloading trucks; shipping and receiving; order picking/packing products; staging and stocking items

Education

Diploma -

Grandview High School
Grandview, MO
05.2006

Skills

  • Multitasking
  • Teamwork skills
  • Reliability
  • Microsoft Office
  • Prior Authorization/Precertification
  • Data Entry
  • Customer Service
  • Ability to Work Independently
  • Adaptability
  • Solution-Oriented

Timeline

Claims Specialist

State Farm
11.2022 - Current

Prior Authorization Representative

Aetna
11.2018 - 11.2022

Customer Care Rep

Anthem
09.2016 - 10.2018

Service Advisor

US Bank
03.2013 - 08.2016

Warehouse Associate

Cardinal Health
02.2008 - 02.2013

Diploma -

Grandview High School

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