- Growing herbs, vegetables, or fruits in home gardens
- Enjoying the art of baking and pastry-making, experimenting with recipes
- Learning new cooking techniques and expanding my culinary skills
- Historical Exploration
- Theme park travel
- Avid Reader
- Horseback Riding
- Camping
Shelby Phillips
Lebanon,TN
Summary
Dynamic and results-driven appeals professional with a proven record of resolving complex cases accurately and ensuring compliance. Recognized for analytical problem-solving, adaptability, and impactful communication. Skilled in fostering collaboration and positive team engagement within remote environments.
Overview
7
7
years of professional experience
Work History
Grievance and Appeals Analyst I
Elevance Health, Inc.
03.2020 - Current
- Reviewed, analyzed, and processed non-complex grievances and appeals in compliance with regulatory standards, accreditation requirements, and internal policies.
- Conducted in-depth research and interpretation of clinical and claims documentation to render determinations or escalate cases for medical review.
- Ensured accuracy and consistency in appeal documentation while managing a high volume of cases and meeting strict resolution deadlines.
- Led workflow improvement initiatives and developed staff training materials, reducing turnaround times and improving customer satisfaction.
- Mentored junior analysts and contributed to policy development, integrating industry regulations and best practices into organizational processes.
Customer Service Rep- RFI
Elevance Health, Inc.
08.2019 - 03.2020
- Review and process incomplete Medicare Advantage and Prescription Drug Plan applications by reaching out to applicants and representatives to gather missing information.
- Ensure all applications meet CMS compliance requirements prior to submission.
- Fill in as a substitute team lead to offer support and guidance to other team members.
- Resolved customer inquiries through effective communication and problem-solving techniques.
- Led initiatives to improve customer satisfaction scores through targeted outreach programs.
Customer Service Rep I-II
Elevance Health, Inc.
07.2018 - 08.2019
- Educate members of their qualifying plan options, benefits, and reviewing complex claim issues.
- Locate in network providers and assist in scheduling various health services.
- Resolved customer inquiries efficiently using CRM software to enhance service quality.
- Mentored junior representatives, sharing best practices to boost team performance and morale within the department.
- Collaborated with team members to streamline communication processes, improving customer satisfaction ratings.
- Managed high-volume calls, ensuring accurate information delivery while maintaining professionalism under pressure.
- Team representative in the Sunshine Committee, planning events for the purpose of uplifting employee engagement and morale.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
Education
Bachelor of Science - Communication, Organizational Communication Con.
Middle Tennessee State University
Murfreesboro, Tennessee01.2018
Skills
- Case evaluation
- Verbal communication
- Legal research
- Policy interpretation
- Customer service
- Insurance policy knowledge
- Problem-solving abilities
- Claims investigation
- Teamwork and collaboration
- Time management
Accomplishments
- Nominated by peers to serve on the Sunshine Committee, representing the department and organizing employee engagement and recognition initiatives.
- Developed and facilitated “Tell Me Something Good” sessions, as well as virtual coffee breaks and wellness-focused brain breaks to foster team morale and connection.
Interests
Timeline
Grievance and Appeals Analyst I
Elevance Health, Inc.
03.2020 - Current
Customer Service Rep- RFI
Elevance Health, Inc.
08.2019 - 03.2020
Customer Service Rep I-II
Elevance Health, Inc.
07.2018 - 08.2019
Bachelor of Science - Communication, Organizational Communication Con.
Middle Tennessee State University
CAREER & EDUCATION ACHIEVEMENTS
Interpersonal Communication, Business Communication, Intercultural Communication, Conflict and Organizations, Small Group Communication, Communication Auditing and Consulting, Leadership Theories and Practices, Experiential Learning Scholar, Anthem Sunshine Committee, Peer Mentor