Summary
Overview
Work History
Education
Skills
Timeline
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Sheila Donohue

Pollock Pines,California

Summary

Well-qualified Human Resources Specialist with proven success in improving operations and solving complex problems in a timely fashion. Highly proficient in building lasting relationships with key decision makers, customers and team members to further organizational goals. Ready to leverage training and experience to take on new professional challenges.

Overview

9
9
years of professional experience

Work History

Human Resources Specialist

Blue Shield of California
05.2023 - Current
  • Maintain over seven thousand personnel records and employment data to establish accuracy and compliance with applicable regulations using the Oracle system.
  • Implement onboarding and orientation programs for new employees in addition to processing employment terminations.
  • Administer employee benefits and assist with benefit open enrollment.
  • Complete sanction check process to maintain legal employment compliance.
  • Develop job aides for internal process completion.
  • Collaboration to identify and address employee relations issues and worker's compensation claim filing.
  • Timely management of cases related to benefits, retirement, leave of absence, payroll, and employee assistance.

Appeals & Grievance Coordinator

Blue Shield of California
10.2022 - 05.2023
  • Researched customer medical claims by communicating with internal and external contacts while meeting strict deadlines.
  • Triaged and authorized decision on high-dollar claim appeals to ensure a fair and accurate outcome.
  • Communicated denial and approval outcomes citing evidence of coverage details while following strict writing guidelines.
  • Collaborated with various internal departments and to maintain compliance.

Correspondence Phone Support, Advanced

Blue Shield of California
10.2020 - 10.2022
  • Adjusted medical claims while following strict desk level procedures to ensure state, federal, and organizational compliance.
  • Conducted outreach to medical providers and facilities to resolve customer inquiries pertaining to eligibility, prior authorization status, and financial liabilities.
  • Worked on the real time assist call line taking over escalated customer calls to maintain customer satisfaction.
  • Collected premium payments from customers.
  • Prepared correspondence such as explanation of benefits, claims, billing inquiries, and service complaints.

Shift Supervisor

Starbucks
11.2014 - 05.2020
  • Established effective employee schedules and delegated tasks to take advantage of individual abilities and meet expected demands.
  • Managed inventory and ordered supplies to keep location well stocked with necessary supplies.
  • Resolved customer complaints and proposed thoughtful solutions to maintain customer satisfaction.
  • Helped store management meet standards of service and quality in daily operations.
  • Trained new employees and delegated daily tasks and responsibilities.

Education

Master of Arts in Organizational Management -

University of Arizona Global Campus

Bachelor of Arts in Anthropology -

Arizona State University

Bachelor of Arts in Political Science -

Arizona State University

Skills

  • Benefits Administration
  • Customer Relations
  • Complex Problem-Solving
  • Confidential Document Control
  • Benefits and Compensation
  • Onboarding and Orientation
  • Conflict Resolution
  • HR Software Proficiency
  • HR Policies and Procedures
  • Procedure Compliance

Timeline

Human Resources Specialist

Blue Shield of California
05.2023 - Current

Appeals & Grievance Coordinator

Blue Shield of California
10.2022 - 05.2023

Correspondence Phone Support, Advanced

Blue Shield of California
10.2020 - 10.2022

Shift Supervisor

Starbucks
11.2014 - 05.2020

Master of Arts in Organizational Management -

University of Arizona Global Campus

Bachelor of Arts in Anthropology -

Arizona State University

Bachelor of Arts in Political Science -

Arizona State University

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Sheila Donohue