Shamira Edwards, Mba Email & Phone Number

• Acted as a liaison operating globally to support business partners across various functions including logistics, incentives, pricing/billing, finance, controllership, and IT to identify and understand the needs of our business stakeholders.• Business owner and main point of contact of Customer Master data, which entails maintaining the integrated ecosystem of data within OTD-S, eSAP, and Finance Core systems.• Executed user acceptance testing (UAT) for new system functionality and any enhancements.• Validation of user stories to determine and confirm that the desired system functionality is accurate and successfully meeting expectations.• Monitored and resolved errors for system inbound/outbound interfaces and be able to communicate any system changes and error resolutions.

•Data Analysis: Utilized Excel for regular plan administration duties and intricate pension benefit calculations to ensure data accuracy and resolution of issues.•Quality Assurance: Conducted reviews and provided final approval over analysts’ work and correspondence prior to distribution. •Financial Analysis & Process Improvement: Computed and initiated payments, updated trustee systems, and drafted and implemented standard procedures for process enhancements.

***Merge with Meridian Health Plan•Data Compilation and Analysis: Utilized Excel to compile and analyze data, creating routine transition of care reports for inpatient hospital admissions and discharges. Ensured timely distribution to the team and provided guidance on reporting guidelines and deadlines.•Operational Support: Assisted supervisor and upper management with various operational tasks, including enrolling new members into caseloads, performing validations, training and mentoring new hires, and conducting special assignments as requested.•Consultant: Acted as a consultant to the supervisor, offering second opinions on inquiries from Care Managers to aid in problem resolution and process improvement.•Member Needs Assessment: Collaborated with Medicare/Medicaid members to identify special needs through health risk assessments and other resources, ensuring comprehensive care.•Care Coordination and Education: Educated and coordinated care for members with special needs to foster compliance with the program and improve outcomes. Educated providers on community resources, program components, and available support services.•Care Plan Management: Assisted in the modification and management of care plans in collaboration with the member, medical consenter or caregiver, and managing physician.

***Now a Centene Corporation Company• Prioritized caseload and multiple other work assignments according to urgency and importance in order to meet time sensitive deadlines and train new hires on team on processes and procedures.• Used Microsoft Excel to track daily workload production and caseload compliance to identify and implement necessary steps on departmental required improvements based on results.• Demonstrated analytical reasoning through case management of Medicaid/Medicare members to assess, plan, implement, coordinate, monitor, and evaluate benefits, services, and outcomes to maximize the health of members on the plan.• Coordinated socioeconomic needs and service member populations across the continuum of illness.• Managed assigned caseload of members while remaining in compliance with all internal and regulatory requirements.• Acted as a liaison between the member, PCP, family/caregiver, and specialists as needed to evaluate the individuals’ needs, goals, and develop a plan of action.• Maintained HIPAA standards and confidentiality of protected health information and demonstrate compliance with HIPAA regulations, professional conduct, and ethical practices.

• Supported team lead in meeting demanding deadlines through preparing and distributing daily reports in Excel and the development of training materials and job aids for the onboarding process of new hires.• Acted as subject matter expert and troubleshot all problems to create resolutions or make recommendations for improvements.• Independent oversight and management of business email correspondence for timely responses of conflict resolution and inquiries to client. • Made timely claim determinations to approve or deny non-complex disability claims and determine benefits due for claim payments and adjustments.• Informed claimants of documentation required to process claims, required time frames, and payment information.

• Acted as subject matter expert and troubleshot all problems to create resolutions or make recommendations for improvements.• Compiled data in Excel for daily routine reports and distributed to team with deadlines and documented results to supervisor.• Independent oversight and management of business email correspondence for timely responses of conflict resolution and inquiries to client. • Mentored all new colleagues and acted as liaison for conflict resolution of claimant/client issues. • Managed caseload of 200-300 claims and identified a plan of action to make timely case determinations on approval or denial.• Analyzed reported FMLA claims data to determine eligibility in compliance with state and federal regulations and ensuring claim management is within company service standards.• Reviewed medical certification to ensure all documentation submitted substantiates claim.• Communicated any decisions, benefits, and expectations with claimants and clients while maintaining a professional claimant/client relationship.

• Tracked and coded all documentation in accordance with internal workflow processes and procedures.• Independent oversight and management of business email correspondence for timely responses of conflict resolution and inquiries to client. • Managed caseload of 200-300 claims and identified a plan of action to make timely case determinations on approval or denial.• Analyzed reported FMLA claims data to determine eligibility in compliance with state and federal regulations and ensuring claim management is within company service standards.• Reviewed medical certification to ensure all documentation submitted substantiates claim.• Communicated any decisions, benefits, and expectations with claimants and clients while maintaining a professional claimant/client relationship.

• Acquired proficiency in recreation software systems such as Class and REC1 to use for the management of special events, programs, membership validation, and facility bookings.

• Prepared financial aid materials and categorized incoming mail and delivered to the proper department and recipient. • Independent supervision of the clerical area involving answering incoming calls and securely confirming caller’s identity and inquiry, then directing the call to the most suitable specialist for resolution.

• Overall management of the entire facility including encouraging the safety and wellbeing of all occupants and visitors through sustaining continuous upkeep. • Ensured quality through directly documenting and reporting all policy violations to upper level management in a discreet, efficient, and timely manner. • Designed monthly programs to engage residents and stimulate an active, hands on learning environment intriguing to all members of the residence hall community. • Conducted interviews of all qualified candidates and evaluated their performance based on leadership and team building exercises to determine those who possessed the skills necessary to lead in the upcoming school year and guarantee future success in the residence halls. • Commended for the demonstration of quick-thinking and resourcefulness in regards to an unexpected, time sensitive matter involving a policy violation that required an instantaneous decision.

• Functioned as the primary line of contact for first year students in the residence halls to greet those entering the building, receive and organize mail and packages, arrange sensitive information and files, provide general information to students and visitors, and answer phone calls. Additional tasks included logging hours to submit our individual biweekly payroll.

Master Of Business Administration - Mba, Human Resources Management And Services

Bachelor Of Science (B.S.), Health/Health Care Administration/Management