Shaune Vaughn
Sacramento
Summary
Results-driven professional with strong technical troubleshooting and data analysis skills. Proven ability to streamline processes and enhance operational efficiency in claims processing and customer service.
Analytical professional with over 10 years of experience in claims processing and customer service. Skilled in technical troubleshooting and workflow optimization, contributing innovative solutions that drive operational efficiency and cost savings.
Overview
17
17
years of professional experience
Work History
Grievance & Appeals
Delta Dental of California
Sacramento
09.2017 - 03.2020
- Utilized advanced technical skills and expertise to troubleshoot complex problems and implement solutions.
- Conducted comprehensive research and data analysis to support strategic planning and informed decision-making.
- Utilized various software and tools to streamline processes and optimize performance.
- Achieved cost-savings by developing functional solutions to problems.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
- Completed day-to-day duties accurately and efficiently.
Claims Processor
Delta Dental of California
Sacramento
09.2009 - 09.2017
- Processed dental claims efficiently for prompt member service.
- Reviewed claim submissions for accuracy and completeness.
- Utilized claims processing software to manage workflows.
- Updated member records in the database accurately.
- Ensured compliance with regulatory requirements during processing.
- Assisted in training new staff on claims procedures and systems.
- Processed a high volume of incoming claims in accordance with established policies and procedures.
Customer Service Representative
Delta Dental of California
Sacramento
03.2003 - 09.2009
- Assisted customers with inquiries regarding dental insurance plans and benefits.
- Resolved customer complaints through effective communication and problem-solving skills.
- Processed claims efficiently using company-specific software systems and tools.
- Educated clients on policy details, coverage options, and claim procedures.
- Documented customer interactions accurately in the customer relationship management system.
Education
High School Diploma -
Oakland High School
Oakland, CA06-1993
Skills
- Claims processing
- Data analysis
- Regulatory compliance
- Technical troubleshooting
- Workflow optimization
- Customer relationship management
- Policy development
- Problem solving
- Team collaboration
Timeline
Grievance & Appeals
Delta Dental of California
09.2017 - 03.2020
Claims Processor
Delta Dental of California
09.2009 - 09.2017
Customer Service Representative
Delta Dental of California
03.2003 - 09.2009
High School Diploma -
Oakland High School