Shelley Williamson
Beaverdam,VA
Summary
Operations-focused healthcare professional with strengths in grievance and appeals review, quality audits, and team supervision. Brings practical leadership in training, workload balancing, and interdepartmental coordination to maintain compliance and consistent service delivery.
Overview
8
8
years of professional experience
Work History
Grievance & Appeals Analyst Lead
Anthem, Inc.
12.2024 - Current
- Lead team of grievance and appeals analysts, coaching and training members to enhance performance and ensure high-quality outcomes.
- Perform quality audits and verify compliance, timeliness, and accuracy standards remain met or exceeded.
- Assign work, manage team inventory, and monitor production metrics to support operational efficiency.
- Process time-off requests, track attendance, and balance workloads for consistent service delivery.
- Act as primary contact for interdepartmental communication, resolving escalated issues to maintain operational flow.
- Identify process improvement opportunities and collaborated with management to implement best practices for enhanced efficiency.
Grievance & Appeals Analyst
Anthem, Inc.
07.2022 - 12.2024
- Reviewed and processed member grievances and appeals, ensuring accurate benefit determinations and timely claims resolution.
- Performed root-cause analysis on claim discrepancies, implementing adjustments to enhance accuracy of future claims.
- Reviewed correspondence and case outcomes for compliance with CMS and internal quality standards.
- Collaborated with cross-functional teams to enhance operational accuracy and elevate member satisfaction.
Customer Service Representative (Medicare Division)
Anthem, Inc.
05.2021 - 07.2022
- Handled escalated issues promptly to enhance member satisfaction and improve retention rates.
- Assisted Medicare members with benefit and claim inquiries, ensuring understanding and satisfaction through empathy and professionalism.
- Documented member interactions to maintain accuracy and adherence to CMS compliance standards.
General Manager
Dave & Phriends Grill
05.2019 - 05.2024
- Coordinated daily operations through staffing schedules and financial tracking, ensuring smooth service and efficient workflow.
- Recruited, trained, and supervised front-of-house and kitchen staff, fostering a high-performing team environment.
- Managed ordering, vendor communication, inventory tracking, and cost review to enhance profitability.
- Built menus, pricing plans, and operating processes to improve efficiency and reduce waste.
- Completed opening and closing routines, register counts, and cash checks to maintain accurate records.
Skills
- Grievance and Appeals Processing
- Compliance & CMS Regulations
- Audit & Quality Assurance
- Root-Cause Analysis
- Operational Efficiency
- Healthcare Operations Management
- Cross-Department Collaboration
- Team Leadership
- Member Experience Enhancement
Timeline
Grievance & Appeals Analyst Lead
Anthem, Inc.
12.2024 - Current
Grievance & Appeals Analyst
Anthem, Inc.
07.2022 - 12.2024
Customer Service Representative (Medicare Division)
Anthem, Inc.
05.2021 - 07.2022
General Manager
Dave & Phriends Grill
05.2019 - 05.2024