Allison Shelton
Indianapolis,IN
Summary
Insurance Appeals Coordinator with expertise in claims management and appeals processing. Skilled in analyzing denials and identifying trends to drive successful resolutions. Collaborates with healthcare providers and insurance companies to ensure timely claims adjudication. Proficient in creating detailed documentation and manual resolution letters in compliance with CMS guidelines.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Appeals Analyst II
Elevance Health
Indianapolis, Indiana
01.2025 - Current
- Analyzed appeals data to identify trends and patterns in case reviews.
- Reviewed denial letters for adherence to regulatory guidelines and company policies.
- Collaborated with cross-functional teams for efficient resolution of complex appeal cases.
- Documented findings and recommendations in detailed management reports.
- Maintained accurate records of all appeal submissions and outcomes in the database.
- Communicated with members to clarify appeal statuses and next steps.
- Monitored progress on pending appeal cases to ensure timely dispute resolutions.
- Created presentations to outline trends identified through claims data analysis.
Appeals Coordinator
IU Health Plans (aquired by Elevance Health)
Indianapolis, IN
06.2015 - 12.2024
- Ensured timely responses to member inquiries regarding appeals status.
- Collaborated with physicians, nurses, administrators, and other staff members to resolve issues quickly and efficiently.
- Compiled and documented information for appeal cases.
- Advised patients on the status of their appeals and any follow-up actions required.
- Conducted research on billing regulations as needed to inform decision making.
- Tracked progress of ongoing appeals cases using computer software systems (Excel).
- Answered incoming calls from providers seeking assistance with appeals processing.
- Maintained records of all appeal activities in a timely manner.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
Customer Solutions Representative
IU Health Plans Insurance
Indianapolis, Indiana
08.2008 - 07.2015
- Educated clients on benefits and services available through health plans.
- Resolved complaints by coordinating with internal departments effectively.
- Provided customer service to a variety of clients through phone, email and other channels.
- Monitored incoming calls and emails for customer support issues.
- Resolved customer inquiries in an efficient and timely manner.
- Coordinated with internal teams to ensure timely and successful delivery of solutions according to client needs.
Education
High School Diploma -
Cardinal Ritter Highschool
Indianapolis, IN05-1983
Some College (No Degree) - Marketing Management
University of Indianapolis
Indianapolis, INSome College (No Degree) - Business Communication
IUPUI
Indianapolis, INSkills
- Regulatory compliance
- Case management
- Documentation accuracy
- Customer relationship management
- Appeals processing
- Trend identification
- Problem solving
- Attention to detail
- Effective communication
- Time management
- Verbal communication
- Team collaboration
- Problem-solving
- Benefits review
- Multitasking capacity
- Goal setting
- Continuous improvement
- Written communication
Certification
I have an Accident and Health Insurance License
Accomplishments
- I received 100% on my Annual Medicare CMS Audits
Affiliations
Grievance and Appeals Training for New Hires.
Enrolled in Grievance and Appeals annual training classes.
Timeline
Appeals Analyst II
Elevance Health
01.2025 - Current
Appeals Coordinator
IU Health Plans (aquired by Elevance Health)
06.2015 - 12.2024
Customer Solutions Representative
IU Health Plans Insurance
08.2008 - 07.2015
High School Diploma -
Cardinal Ritter Highschool
Some College (No Degree) - Marketing Management
University of Indianapolis
Some College (No Degree) - Business Communication
IUPUI