CHERYL JARVIS
Pembroke Pines
Summary
- A problem-solver with strong analytical skills and attention to detail.
- A skilled communicator, both written and verbal, who can explain complex information clearly.
- Experienced in handling multiple tasks in a fast-paced environment without missing a beat.
- Knowledgeable about health insurance, Medicare, CMS, and regulatory guidelines.
- Experienced Grievance and Appeals Specialist with over 9 years in health insurance administration, specializing in claims analysis, billing analysis and resolution, critical thinking, and regulatory compliance. Proven track record in managing high volume caseloads, resolving complex member issues, and ensuring CMS and HIPPA compliance. Adept at detailed investigation, clear communication, and delivering high quality service in a fast-paced environment.Professional with extensive experience in analyzing and processing member appeals, grievances, claims, and billing issues in accordance with CMS regulations and internal policies. Demonstrated proficiency in health plan operations by reviewing member records and coordinating with various departments to gather necessary documentation. Effectively drafted professional correspondence and case summaries while ensuring compliance with regulatory standards. Maintained detailed case documentation in CRM systems, contributing to improved workflow optimization and issue resolution.
Overview
6
6
years of professional experience
1986
1986
years of post-secondary education
Work History
Appeal and Grievance Specialist
Bright Healthcare/Molina Healthcare
02.2022 - Current
- Analyzed and processed IFP and Medicare member appeals, grievances, claims, and billing issues with CMS regulations and internal policies.
- Demonstrated strong knowledge of health plan operations, workflows, and system navigations by reviewing member records, benefits, claims and billing issues, coordinated with internal departments and contracted members and providers to gather supporting documentation.
- Drafted clear professional, and member friendly correspondence and case summaries. Ensured accuracy and consistency in verbal and written communications.
- Prepared case files, for independent review Entities (IRE’s), ensuring proper organization and compliance with regulatory time frames.
- Escalated sensitive or high-risk issues to management when appropriate.
- Maintained detailed case documentation in internal tracking systems (CRM), ensuring adherence to all CMS, state, and organizational standards.
- Managed intake investigation, documentation.
- Coordinated additional actions with cross-functional teams to address root-causes and prevented re-occurrences.
- Conducted claim reviews for processing errors and submitted correct claims when necessary.
Benefits Counselor
Eastridge Staffing (Assigned to Benefit Harbor)
11.2019 - 01.2022
- Provided employee benefits counseling and enrollment support for clients of Benefit Harbor.
- Assisted individuals in understanding and selecting appropriate health, dental, vision, life, and other voluntary benefits during open enrollment and qualifying life events.
- Educated employees on plan options, eligibility, and coverage details, ensuring compliance with federal and employer specific guidelines.
- Delivered high quality and empathetic customer service via phone and digital platforms, maintain confidentiality and HIPPA compliance.
- Accurately entered and reviewed benefits elections in internal system, resolving discrepancies and escalating complex issues as needed.
Special Service Team-Intake Specialist
Bright Healthcare
- Serves as the initial point of contact for member escalations and grievances submitted via email and internal systems.
- Verified member information and routed cases to the appropriate department for resolution.
- Maintained detailed, accurate records in internal databases to ensure consistent follow-up and reporting.
- Performed initial screening of email inquiries and endured timely distribution to relevant teams.
Membership and Enrollment Specialist
Bright Healthcare
- Provided level 1 support for enrollment, eligibility, and premium billing inquiries via inbound calls.
- Collaborated with internal teams and external partners to resolve enrollment issues, including disputes with state and federal marketplaces.
- Assisted members with premium payments, billing discrepancies, including support for those in grace periods.
- Ensured accurate communication of enrollment status, benefits, and financial assistance programs such as ATP and CSR.
- Identified trends in member concerns and participated in root cause analysis for recurring issues.
- Maintained strong relationships with members by delivering responsive, empathetic, and solution focused service.
Education
Herrin High School
Herrin, ILSkills
- Appeal processing
- Grievance analysis
- Case documentation
- Regulatory compliance
- Member communication
- Claims management
- Root cause analysis
- Benefit counseling
- Enrollment support
- Billing resolution
- CRM systems
- HIPAA compliance
- Customer service
- Cross-functional collaboration
- Member education
- Issue escalation
- Data entry accuracy
- Workflow optimization
- Internal reporting
- Conflict resolution
- Premium billing
- Member relationship management
- Complaint handling
- Mediation techniques
- Dispute resolution
- Assertiveness
- Problem-solving aptitude
- Adaptability
- Active listening
- Time management abilities
- Business correspondence writing
- Self motivation
- Case management
- Interpersonal skills
- Analytical thinking
- Time management
- Multitasking Abilities
- Compliance management
- Reliability
- Teamwork and collaboration
- Professionalism
- Data analysis
- Employee training
- Goal setting
- Team collaboration
- Critical thinking
- Problem-solving abilities
- Decision-making
- Interpersonal communication
- Conflict management
- Grievance handling
- Adaptability and flexibility
Timeline
Appeal and Grievance Specialist
Bright Healthcare/Molina Healthcare
02.2022 - Current
Benefits Counselor
Eastridge Staffing (Assigned to Benefit Harbor)
11.2019 - 01.2022
Special Service Team-Intake Specialist
Bright Healthcare
Membership and Enrollment Specialist
Bright Healthcare
Herrin High School