Appeal And Grievances Coordinator resume example with 17+ years of experience

(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
Professional Summary
Results oriented and organized individual with strong communication and analytical skills and the ability to work effectively on multiple projects in a high volume business environment. Experienced in all aspects of analytical reporting, information research and operational processes.
Skill Highlights
COMPUTER SKILLS Prime Health Net, Caremark Health Net Unity health Net, Microsoft Word, Microsoft Excel, Microsoft PowerPoint, SharePoint, Outlook, SQL, AS400, Siebel, CFSC Loan Processing Software, IPortal, Equator, Siebel, Bank Of America Homesaver, Bank Of America Homebase, Bank Of America CRM Tool, Lamp.
Education and Training
Moorpark College , Expected in 1998 Associates : - GPA : Moorpark College (1995 - 1998) Candidate for Associates' Degree
Simi Valley High School , Expected in 1995 High School Diploma : - GPA : Simi Valley High School (1995) High School Diploma
Professional Experience
Marsh & Mclennan Companies, Inc. - Appeal and Grievances Coordinator
White Plains, NY, 12/2014 - Current
  • Researches, investigates and resolves administrative member complaints and appeals and assists with DMHC, URAC and Health Plan audit preparation
  • Documents the results of complaints and appeals and dispositions at all levels including notification to providers and members.
  • Prepares case files on clinical member and provider appeals for medical director review.
  • Prepares clinical complaint resolution letters under guidance of clinical staff. Processes, researches, and resolves provider disputes as assigned.
  • Generates complaint, appeal and provider dispute acknowledgement and resolution letters and medical records requests.
Pizza Hut - Operations Analyst
Grand Prairie, TX, 07/2010 - 02/2014
  • Analyzed complaints submitted by customers and generated reports for Managers and Officers of the Company.
  • Assisted in projects and business activities to create reports for department.
  • Analyzed and exported data from SharePoint and to excel and presented to Senior Management Team.
  • Utilized AS400 and Siebel to gather and summarize complaints binding them to their respective loans.
  • Subject Matter Expert for Customer Support Claims Department which consisted of monitoring all incoming inquiries and distribution amongst departmental teams for resolution. Also determined which inquiries should be classified as escalations and expedited.
  • Received highest customer satisfaction rating "A Level" from system generated customer feedback tool based on speed, accuracy and customer service.
Southwest Business Corporation - Restaurant Manager
Dallas, TX, 11/2006 - 12/2009
  • Managed total restaurant operations in areas of staff management, customer relations, vendor relations, budgets, inventory control, and purchasing of food, beverages and small wares.
  • Effectively lead and motivate employees through implementation of in-house training and incentive plans, resulting in increased productivity levels and employee satisfaction.
  • Handled weekly inventory and vendor relations to ensure the timely and cost-effective purchasing of food, beverages, liquor, beer and small wares. Managed $8.0 million restaurant.
  • Ensured the integrity of restaurant operations through excellence in customer relations.
Applied Card Systems - Suspense Coordinator
Rehoboth Beach, DE, 03/2003 - 09/2006
  • Responsible for the daily processing of ten major company accounts.
  • Prepared reports for loan applications and organized meetings with lenders to promote new ideas and develop underwriting & lending policies & procedures.
  • Validated mortgage loan applications via industry best practices to ensure compliance with corporate and regulatory guidelines.
  • Cleared and conveyed title, processed conventional loans, compliance, and legal documentation.
  • Assisted supervisor with special projects targeted at improving team performance goals.
Bank Of America - Bank Teller
City, STATE, 07/1997 - 07/1998
  • Processed transactions for personal and business customers and provided information regarding new accounts, savings bonds, loan payments, certificates of deposit, and other bank services.
  • Performed nightly cash audits and filed reports to ensure accuracy of daily transactions.
  • Trained and mentored new tellers as part of team-oriented approach to customer service.
Received highest customer satisfaction rating "A Level" from system generated customer feedback tool based on speed, accuracy and customer service
Loans, Operations, Satisfaction, Customer Service, Receptionist, Retail Sales, As400, Claims, Customer Support, Excel, Microsoft Sharepoint, Sharepoint, Siebel, Subject Matter Expert, Best Practices, Conventional Loans, Documentation, Legal Documentation, Lending, Mortgage, Mortgage Loan, Underwriting, Budgets, Buying/procurement, Customer Relations, Inventory, Inventory Control, Million, Purchasing, Restaurant Manager, Training, Audits, Bank Teller, Cash, New Accounts, Payments, Audit, Medical Records, Clerical Loan, Crm, Customer Relationship Management, Lamp, Lamp Stack, Loan Processing, Microsoft Excel, Microsoft Powerpoint, Microsoft Word, Outlook, Powerpoint, Sql, Word

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Resume Overview

School Attended

  • Moorpark College
  • Simi Valley High School

Job Titles Held:

  • Appeal and Grievances Coordinator
  • Operations Analyst
  • Restaurant Manager
  • Suspense Coordinator
  • Bank Teller


  • Associates
  • High School Diploma

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