SHALENA JONES

SUMMARY

Career orientated business professional who has worked and has gained experience, expertise, and dedication in membership billing analyzing managing information data, claims processing and loan processing. Have worked with insurance agents utilizing integrity, resilience, and attention to detail skills. Known for maintaining performance standards, accuracy, and ability to work independently to achieve team goals. Awarded MVP and The Pillar of Strength at my prior position. Responsible to budget, analyze over two-hundred student files and to allocate and award two- hundred sixty-nine thousand dollars in monetary funds. Known to exceeded quota and standards at prior position held. PROFESSIONAL EXPERIENCE

PNC, Pittsburgh, PA 11/2018 – Present

Operations Analyst

• Executes complex transactions/processes utilizing standards procedures.

• Processes and reconciles complex transactions of varying risk and financial value in accordance with established policies and procedures.

• Identifies and addresses exceptions and serves as a point of escalation for complex transactions.

• Partners internally with service partners to route calls, documents and other actions items.

• Interacts with external customers to complete transactions. Gateway Health Plan, Pittsburgh, PA 02/2018 – 11/2018 Customer Service Representative

• Engages with customers in a confident and compelling manner.

• Selected by management to receive cross training in multiple roles, within first five months of employment.

• Performing the full range of customer service duties and responsibilities assigned.

• Routinely responds to customers with an in-depth product knowledge achieved through continuously improving listening, analysis, and quality-focused.

• Provides distributive pharmacy services, assistance for support for all registered pharmacist.

• Initiate outreach efforts, primarily by telephone, related to target preventive health initiatives. Community College of Allegheny County 08/2017 – 01/2018 Accounting Clerk

• Serve as financial aid resource to help locate grant and scholarship opportunities.

• Assist in enrollment express, analyzed student refunds, prioritize urgent student payments prior to deadline.

• Enters data and scans and links students’ documentation using Ellucian Colleague system and Image Now.

• Receives, screens, and refers telephone calls, emails, and students in person.

• Publicizes and promotes events and activities.

• Contacts students with incomplete FAFSA application and non-payment.

• Present financial and information to students and families. Highmark, Inc. Pittsburgh, PA 10/2014 – 05/2017

Installation Design Coordinator

• Evaluated various systems and generated enrollment status and skills and jobs expectations into an automated system processing system. Responsible to analyze the financial needs of clients, deductible, coinsurance patient responsibility from a variety of sources including documentation of financial status and review and conducting personnel.

• Analyzed and communicated with Sales department rates, monetary amounts, and benefit changes options to ensure accuracy. Operated with other for product interactions reviewed quality results and improvement opportunities.

• Responsible to communicate effectively with customers, colleagues, and management to ensure any conflicts in benefit coding and transactions were addressed in a timely manner. Thanks

Argosy University Online Programs 11/2011 – 02/2014 Student Finance Counselor

• Entrusted with the development and execution of Annual Plans, monthly forecast process and various analysis.

• Assisted with developing, tracking risks models supported the monthly accounting close to ensure accounting guidelines are appropriately reflected in the financials.

• Responsible to analyze the financial needs of students from a variety of sources including documentation of financial status and review and conducting personnel interviews. PNC Bank, Pittsburgh, PA 06/2011 – 11/2011

Funds Transfer Representative

• Received and verified incoming wire transfers for PNC clients.

• Entered wire transfer requests to core system provider to ensure accuracy of information.

• Reviewed input of wire transfers and payroll requests keyed into PNC core system.

• Fulfilled transfer agency requirements for monitoring transactional data for PNC clients. Highmark, Inc. Pittsburgh PA 01/2003 – 10/2010

Claims Processor/Clerk

• Screened, reviewed, evaluated online entry, error correction and/ or quality control review and final adjudication of paper/electronic claims. Determined whether to return, deny or pay claims following organizational policies.

• Resolved claims edits, reviewed historical records to determine benefit eligibility for service. Reviewed payment levels to arrive at final payment determination.

• Scanned, filed, and copied claims and removed unsustainable claims. EDUCATION & CREDENTIALS

Still Attending: Point Park University, Pittsburgh PA Senior 99 credits, Accounting Major, Expected Graduation in 2018 July 2000: Duffs Business Institute, Pittsburgh P.A.15212 Profession Certificate in Computer Operations

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