Shelby Lester
NEWNAN,GA
Summary
Experienced professional with 4+ years in customer service, medical claims, utilization review, and prior authorization, along with 10+ years in manufacturing, machine operation, and assembly. Skilled in problem-solving, quality control, equipment troubleshooting, and meeting performance goals in fast-paced environments.
Overview
14
14
years of professional experience
Work History
Customer Service Representative II
Elevance Health
Atlanta, GA
08.2022 - 09.2026
- Established and maintained customer accounts, explained services and billing, and educated customers on account requirements and available options.
- Managed inbound and outbound call queues, assisting members and providers with inquiries, claim concerns, benefit questions, and service requests while meeting productivity and quality standards.
- Conducted utilization reviews and processed medical claims while coordinating with providers to gather necessary medical documentation.
- Collaborated with internal departments to resolve customer concerns, improve processes, and ensure timely follow-up.
- Investigated complex medical claims, coordinating with members, providers, insurance carriers, claims representatives, and internal teams to resolve issues.
- Verified member eligibility, benefits, coverage dates, other insurance, and Coordination of Benefits (COB) to support accurate claim processing and payment.
- Researched and resolved claim denials, duplicate coverage, payer sequencing errors, payment discrepancies, and potential overpayments.
- Reviewed medical records, billing documents, Explanation of Benefits (EOBs), and supporting documentation to determine claim accuracy and payment responsibility.
- Audited claims for accuracy, completeness, coding, eligibility, payment accuracy, and compliance with payer guidelines, company policies, and regulatory requirements.
- Provided guidance to team members and leadership on standard operating procedures, claims processes, best practices, and quality standards.
- Supported quality assurance initiatives by identifying errors and analyzing trends, recommending process improvements to enhance accuracy and service quality.
Machine Operator/Technician
Yamaha Motor Manufacturing Corporation
Atlanta, GA
10.2012 - 08.2022
- Set up, operated, monitored, and troubleshot plastic injection molding machines and auxiliary equipment to produce components according to specifications and quality standards.
- Monitored and adjusted machine settings, including temperature, pressure, speed, cycle time, and material feed, to maintain consistent product quality.
- Performed machine startups, shutdowns, mold changes, equipment setups, and process adjustments to maintain safe and efficient production.
- Troubleshot equipment malfunctions, material inconsistencies, process issues, and production defects to minimize downtime.
- Performed routine equipment cleaning, inspections, preventative maintenance, and basic troubleshooting on presses, molds, and auxiliary equipment.
- Reduced scrap and improved production efficiency by identifying process issues and making approved adjustments.
- Operated hoists and material-handling equipment to move materials, molds, and production components safely throughout the manufacturing area.
- Documented production output, machine settings, cycle times, downtime, scrap, and quality inspection results.
- Consistently met production goals, quality standards, and safety expectations in a fast-paced manufacturing environment.
- Performed fast-paced assembly and production tasks while meeting daily quotas, production schedules, and quality requirements.
- Inspected finished parts for visual defects, dimensional accuracy, paint quality, and other quality issues; identified and reported defective products.
- Painted parts and components according to specifications, ensuring proper coverage, finish, and appearance.
- Trained and assisted team members with machine operation, material handling, assembly procedures, quality requirements, and safe work practices.
- Collaborated with production, quality, maintenance, engineering, and management teams to resolve equipment, process, and safety concerns.
- Supported workflow coordination and continuous improvement initiatives to increase productivity, reduce downtime, and improve product quality.
- Followed OSHA requirements, company safety procedures, work instructions, and manufacturing standards.
Education
East Coweta High School
Sharpsburg, GASkills
- Claims processing
- Utilization review
- Benefits verification
- Benefits coordination
- Quality assurance
- CRM software proficiency
- Problem solving
- Attention to detail
- Multitasking and organization
- Written communication
Timeline
Customer Service Representative II
Elevance Health
08.2022 - 09.2026
Machine Operator/Technician
Yamaha Motor Manufacturing Corporation
10.2012 - 08.2022
East Coweta High School