Shannon Shorter
Virginia Beach
Summary
Detail-oriented Claims Processor and Healthcare Administrative Professional with over 7 years of experience in medical claims processing, prior authorizations, coordination of benefits, and healthcare insurance operations. Proven ability to maintain high productivity standards, analyze claim discrepancies, and ensure compliance with payer policies. Strong background in working with providers, internal departments, and insurance systems to resolve billing issues and improve claims accuracy.
Overview
9
9
years of professional experience
2016
2016
years of post-secondary education
Work History
Claims Processor
Elevance Health
07.2025 - 03.2026
- Process and review medical claims to ensure accuracy, completeness, and compliance with payer policies and guidelines.
- Verify member eligibility, provider information, and billing codes prior to claim adjudication.
- Review and process prior authorization requests to confirm medical necessity and payer requirements.
- Validate supporting documentation and clinical information for authorization approvals or denials.
- Communicate with providers and internal departments to resolve claim and authorization discrepancies.
- Apply coordination of benefits (COB), claim edits, and policy guidelines during claim review.
- Maintain productivity and quality standards while meeting daily claim processing goals.
- Contract via Athena Consulting
Client Support Consultant
ADP
Norfolk
08.2023 - 05.2025
- Managed inbound and outbound client support related to payroll processing.
- Guided clients on how to effectively use ADP payroll and HR platforms.
- Troubleshot payroll system issues and provided timely resolution to maintain payroll accuracy.
- Norfolk, VA
Claims Processor
WPS Health Solutions
09.2017 - 08.2023
- Processed claim adjustments according to TRICARE policy including additional payments, reissues, and statistical adjustments.
- Identified and credited refunds to correct claim history.
- Contacted beneficiaries, providers, and agencies to obtain necessary information for accurate account updates.
- Requested recoupment of payments according to TRICARE operational policies.
- Responded to internal and external correspondence including attorneys, insurance companies, and government agencies.
- Coordinated benefits with commercial insurance, Medicare, and other coverage plans.
- Reviewed reports and inventories to prioritize workflow and meet claim processing timelines.
- Utilized ICD and CPT coding while reviewing CMS‑1500 and UB‑04 claims.
- Reviewed claims to ensure accurate reimbursement and cost‑sharing calculations.
- Interpreted legal documents related to claim payments including bankruptcy and custodial judgments.
Education
High School Diploma -
Lake Taylor High School
Norfolk, VASkills
- Medical Claims Processing
- Prior Authorizations
- Coordination of Benefits (COB)
- ICD, CPT, CMS‑1500 & UB‑04 Claims
- Insurance Policy Compliance
- Claims Adjudication
- Customer & Provider Communication
- Problem Solving & Troubleshooting
- Time Management & Productivity
Awards
- President’s List – GPA Above 4.0 (2023 & 2024)
- Phi Theta Kappa Honor Society
Timeline
Claims Processor
Elevance Health
07.2025 - 03.2026
Client Support Consultant
ADP
08.2023 - 05.2025
Claims Processor
WPS Health Solutions
09.2017 - 08.2023
High School Diploma -
Lake Taylor High School