Shelby Sample
West Frankfort
Summary
Resourceful Benefits Service Representative known for high productivity and efficiency in task completion. Skilled in navigating complex benefits systems, interpreting policy details, and managing inquiries with clarity. Possess strong communication, problem-solving, and organizational skills essential for excelling in fast-paced environments. Committed to delivering exceptional service by leveraging expertise in benefits administration to support client needs effectively.
Overview
9
9
years of professional experience
2013
2013
years of post-secondary education
Work History
Benefit Service Representative
Provider Partners Health Plan
Columbia
07.2023 - Current
- Assisted providers in understanding health benefits, resulting in improved clarity and member satisfaction regarding coverage options.
- Processed benefit inquiries efficiently, ensuring accurate information was provided and reducing resolution time for member concerns.
- Collaborated with cross-functional teams to enhance service delivery, leading to streamlined communication and improved operational workflows.
- Verified member appointments and obtained needed authorizations.
- Monitored compliance with health plan policies, which helped maintain high standards of service quality and adherence to regulatory requirements.
- Reviewed documents for accuracy according to established procedures.
- Maintained compliance with all federal regulations related to benefits administration including HIPAA Privacy Rules and Regulations.
- Assisted in resolving discrepancies between systems for benefit administration purposes.
- Checked accuracy and completeness of benefits applications and documents.
Customer Care Specialist
WPS Health Solutions
04.2017 - 02.2019
- Assisted customers with inquiries regarding health insurance plans and services.
- Resolved customer complaints through effective communication and problem-solving techniques.
- Educated members on benefits, coverage options, and claims processes.
- Engaged in continuous learning about healthcare policies to better assist members.
- Created detailed documentation of all customer interactions and transactions.
- Reviewed insurance claims for accuracy and compliance with company policies.
- Investigated claim details through interviews and research to resolve discrepancies.
Education
Frankfort Community High
West Frankfort, ILSkills
- Benefit administration
- Health benefits knowledge
- Compliance monitoring
- Provider support
- Claims processing
- Appointment verification
- Authorization management
- Cross-functional collaboration
- Discrepancy resolution
- HIPAA compliance
- Healthcare regulations awareness
- Salesforce experience
- Benefits explanation
Timeline
Benefit Service Representative
Provider Partners Health Plan
07.2023 - Current
Customer Care Specialist
WPS Health Solutions
04.2017 - 02.2019
Frankfort Community High