Shari Simpson

· As a Grievance Specialist I was responsible for managing and resolving grievances and complaints from clients, customers, or members. The role ensures that all complaints are handled in a timely, professional, and empathetic manner, while adhering to company policies, regulations, and legal requirements. As a Grievance Specialist I collaborated with multiple departments, including customer service, legal, and claims, to investigate, evaluate, and resolve grievances, ensuring customer satisfaction and compliance with all applicable standards.

Processed and finalized appeals and grievances within agreed-upon turnaround time.

• Oversee all aspects of a body sculpting and post-operative recovery spa, including appointment scheduling, inventory management, employee training, and delivery of exceptional customer service
• Also responsible for managing all aspects of a business specializing in non-invasive body contouring treatments, including client consultations, performing procedures using various body sculpting technologies, marketing and sales strategies, staff oversight, maintaining a clean and safe environment, and staying updated on industry trends to ensure client satisfaction and business growth

• As a Claims Intake Specialist, I was responsible for the initial intake, review, and processing of incoming claims from clients, policyholders, or third-party vendors. This role involves gathering relevant information, verifying claim details, and ensuring all necessary documentation is complete before passing the claim onto the appropriate department for further evaluation and processing. As a Claims Intake Specialist, I served as the first point of contact for claims and ensures that claims are efficiently and accurately entered into the system, adhering to company policies and regulatory requirements. Also provided the client with comfort and reassurance that the claim would be handled in a timely manner. Followed up with customers on unresolved issues. Evaluated accuracy and quality of data entered into agency management system. Collaborated with claims department and industry anti-fraud organizations to resolve claims.

• · As a Credentialing/Enrollment Specialist I was responsible for the credentialing and enrollment of healthcare providers into insurance networks, ensuring that they meet all necessary qualifications, standards, and regulatory requirements. This role involves verifying the credentials of healthcare providers, submitting applications for enrollment, and ensuring the timely processing of provider applications with various insurance companies, health plans, and governmental agencies like Medicare and Medicaid. As a Credentialing/Enrollment Specialist I also handled the re-credentialing process to ensure that healthcare providers remain in-network and comply with regulatory guidelines. Communicated effectively via telephone, email, and in person with prospective customers. Understood and thoroughly explained services provided to customers and potential customers.

· As a Humana Insurance Agent, I was responsible for selling and promoting Humana’s health insurance products, including individual and family plans, Medicare Advantage, dental, vision, and prescription drug coverage. This role involves educating potential clients about Humana's offerings, guiding them through the enrollment process, and providing excellent customer service before and after they enroll. Also, as a Humana Insurance Agents I had to stay informed about industry changes, product updates, and regulatory compliance while maintaining relationships with current clients and building a customer base. Developed tailored health insurance plans to meet individualized client needs. Also developed and maintained client databases to track customer service interactions and evaluate service quality.