Shevaun Shomo
Stroudsburg
Summary
Dedicated customer service professional with extensive experience in financial services, insurance, and healthcare industries. Expertise in building strong client relationships, resolving complex issues, and ensuring high levels of customer satisfaction. Proficient in claims processing, insurance verification, billing support, and multi-system account management, complemented by a results-oriented approach and strong communication skills. Recognized for fostering team collaboration and effectively managing provider relations while adapting to evolving operational needs. Exceptional conflict resolution and organizational abilities drive success.
Overview
11
11
years of professional experience
Work History
Provider Services Representative
Capital Blue Cross
Harrisburg, PA
11.2024 - Current
- Obtain insurance authorizations for medical services by verifying patient eligibility and determining medical necessity.
- Coordinate with healthcare providers to ensure coverage for procedures and treatments.
- Gather clinical documentation to support authorization approvals and manage denial processes.
- Maintain accurate records and documentation within practice management systems.
- Communicate with providers regarding benefits, authorization status, and required documentation.
Customer Care Associate III
Guardian Life
Bethlehem, PA
01.2022 - 11.2024
- Managed 50+ daily calls from insured members, employers, brokers, and sales representatives regarding benefits, billing, eligibility, and claims.
- Responded to customer inquiries through phone, email, chat, and text support channels.
- Maintained efficient call control while delivering high-quality customer service.
- Assisted customers with payment processing and account support using multiple administrative systems.
- Provided account information, statement explanations, and balance support to clients.
Personal Lines Customer Service Representative
Patrick McNealis Insurance and Financial Group
Bethlehem, PA
02.2020 - 01.2022
- Followed up with customers to ensure satisfaction and resolve service-related concerns.
- Identified cross-selling opportunities for insurance and financial products.
- Built and maintained strong client relationships to improve retention and loyalty.
- Responded to inquiries and referred complex issues when necessary.
Registration Representative II
Lehigh Valley Health Network
East Stroudsburg, PA
02.2018 - 02.2020
- Provided patients with information regarding admissions, financial requirements, and check-in procedures.
- Verified insurance benefits and processed patient payments.
- Collected demographic and insurance information accurately.
- Scheduled appointments and determined appropriate appointment types within system platforms.
Account Resolution Specialist
Community Health Systems
Bethlehem, PA
09.2015 - 02.2018
- Managed collections and account resolution activities to support accounts receivable goals.
- Performed aggressive follow-up on insurance claims to expedite reimbursement.
- Negotiated payment plans and account settlements with patients and responsible parties.
- Communicated with insurance companies, government agencies, and patients regarding account status.
Education
Associate of Science - Business Administration
Strayer University
Allentown, PAMedical Insurance Billing
CDE Career Institute
Tannersville, PAGeneral Studies
East Stroudsburg High School
East Stroudsburg, PASkills
- Customer Service & Client Relations
- Insurance Verification & Claims Processing
- Billing & Account Resolution
- Customer Complaint Resolution
- Multi-line Phone Systems
- Communication & Problem Solving
- Microsoft Outlook & Excel
- EMR/Epic Systems
- Accounts Receivable
- Data Entry & Documentation
- Team Collaboration
- Process Optimization
- Call center experience
- Goal-oriented mindset
- Claims processing
- HIPAA compliance
Timeline
Provider Services Representative
Capital Blue Cross
11.2024 - Current
Customer Care Associate III
Guardian Life
01.2022 - 11.2024
Personal Lines Customer Service Representative
Patrick McNealis Insurance and Financial Group
02.2020 - 01.2022
Registration Representative II
Lehigh Valley Health Network
02.2018 - 02.2020
Account Resolution Specialist
Community Health Systems
09.2015 - 02.2018
Medical Insurance Billing
CDE Career Institute
General Studies
East Stroudsburg High School
Associate of Science - Business Administration
Strayer University