LiveCareer-Resume

appeals and grievances coordinator resume example with 6+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Summary

I'm a Seasoned Customer Success Manager offering ten years of experience combined with proven customer service, communication, and conflict mediation skills. Computer-related skills include Microsoft Office, Windows, IOS, and medical referral-associated platforms. Successful at defusing upset, angry customers with calm and level-headed approaches. Team-oriented, resourceful, and adaptable to changing demands.

Skills
  • Customer Account Management
  • Verbal and Written Communication
  • Data Entry and Maintenance
  • De-escalation Techniques
  • Customer Service
  • Good Telephone Etiquette
  • Dependable and Responsible
  • Grievance management
  • 42 WPM proficient
  • CPT, ICD and NDC experience
Education and Training
Galt High School Galt, CA Expected in 06/2014 High School Diploma : - GPA :
Experience
Evolent Health, Inc. - Appeals and Grievances Analyst
Linthicum Heights, , 02/2019 - Current
  • Would demonstrate self-reliance by meeting and exceeding workflow needs by displaying 100% compliance audits for multiple months.
  • Managed customer expectations by clarifying needs, identifying options, and recommending client services.
  • Complete about 10-16 cases per week and finish before the final due date.
  • Navigate three types of casework, including medical grievances, medication appeals, and medical appeals throughout my work day.
  • Process claims and/or eligibility records into the system to process claims and update/correct file information.
  • Adhered to company and insurance client's guidelines in claims processes, estimate writing and claim closures.
Us Ecology, Inc. - Home Health Caregiver
Bayonne, NJ, 04/2015 - 01/2019
  • Maintain a clean and well-organized environment for client happiness and safety.
  • Drove clients to shop for groceries, attend doctor appointments and run errands.
  • Assisted clients with daily personal care activities. Check on vital signs and medication use.
  • Performed light housework, handled cleaning duties, and ran loads of laundry.
Ecumen - Lead Barista
Moorhead, MN, 08/2015 - 09/2018
  • Organized shift assignments to meet expected coverage demands.
  • Provided outstanding customer service to new and long-standing customers.
  • Trained new team members on proper service methods and customer care expectations.
  • Managed inventory by establishing and adjusting ordering parameters, accurate forecasting, and monitoring waste.
  • Reconciled daily sales each shift, counting member drawers to analyze discrepancies.
Accomplishments
  • Promotion through Blue Shield from Correspondence Call Center Representative to Appeals and Grievance Analyst.
  • Supervised team of 5 staff members.
  • Customer Relations - Earned highest marks for customer satisfaction, company-wide

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Resume Overview

School Attended

  • Galt High School

Job Titles Held:

  • Appeals and Grievances Analyst
  • Home Health Caregiver
  • Lead Barista

Degrees

  • High School Diploma

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