Courtney Smith
Arlington
Summary
Dynamic Grievance and Appeals Specialist with proven expertise at Dean Health Plan in case research and regulatory compliance. Adept at managing grievances and appeals, ensuring timely resolutions while maintaining high standards of customer service. Recognized for exceptional data entry and report writing skills, driving efficiency and accuracy in all processes.
Overview
25
25
years of professional experience
Work History
Grievance and Appeals Specialist
Dean Health Plan-Madison WI
Madison
06.2021 - 06.2025
- Research each case thoroughly and prepare grievance packets for the Grievance and Appeal Committee members or quality packets for Medical Peer Review Committee, within defined due dates.
- Prepare draft responses to customer appeals grievances, ETF complaints, OCI complaints and IROs within the required timeframe of each.
- Maintain accurate and complete complaint, grievance/Appeal and quality information in the department database in a timely manner.
- Coordinate all follow up and subsequent action needed as a result of a case review.
- Prepare and send appropriate files to ETF, OCI, Maximus and IROs to the appropriate entity within the required time standards.
- Interpret and understand state guidelines and regulations applicable to related insurance.
- Maintain physical and technical security and privacy of protected health information (PHI).
Customer Service
05.2018 - 06.2021
- Responsible for answering phone calls and assisting callers with benefits, claims and billing issues
Sales associate
Shopko Stores- Madison, WI
Madison
12.2002 - 11.2017
- Responsible for the weekly apparel clearance markdowns and maintaining the weekly sales ads.
- Deliver accurate pricing through tickets, labels and signs.
- Maintain a great-looking work area. Resolve guest concerns quickly and accurately.
- Work as part of a fast, fun and friendly team.
- Drive sales by completing price changes quickly and accurately.
- Use extensive pricing knowledge and experience.
- Use excellent planning, organizational and numerical skills.
- Providing customer service to both internal and external customers by answering calls.
- Receive incoming inventory and prepare floor and table for merchandise
- Provide training to new employees
- Function as an informal leader and proved responsibility assignments
- Perform annual stock inventory
Teller
Anchor Bank F.S.B.- Monona, WI
Monona
01.2007 - 04.2007
- I was responsible for processing transactions and providing customer service
- (part time)
Cashier
Shopko Stores- Madison, WI
Madison
12.2000 - 12.2002
- Responsible for providing customer service and ring up their purchases
Education
Business Management
MATC
01.2004
High School Diploma -
DeForest High School
05.2002
Skills
- Grievance management
- Case research
- Regulatory compliance
- Data entry
- Report writing
- Customer service
References
References available upon request.
Awards
Awards received: Two time -Teammate of the Month Award
Timeline
Grievance and Appeals Specialist
Dean Health Plan-Madison WI
06.2021 - 06.2025
Customer Service
05.2018 - 06.2021
Teller
Anchor Bank F.S.B.- Monona, WI
01.2007 - 04.2007
Sales associate
Shopko Stores- Madison, WI
12.2002 - 11.2017
Cashier
Shopko Stores- Madison, WI
12.2000 - 12.2002
Business Management
MATC
High School Diploma -
DeForest High School