Shelly Garvin
Summary
Effective Medical Claims Processor, offering 24 years of experience. Strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
29
29
years of professional experience
Work History
Appeals Specialist
TML Health Benefits Pool , 1821 Rutherford Lane
08.2016 - 02.2023
- Consistently met or exceeded performance metrics, demonstrating a strong understanding of the claims review process and an unwavering commitment to achieving positive results for clients.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
- Acted as a departmental resource on appeals matters.
- Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
- Assisted in refining company policies surrounding claims denials management by sharing insights gleaned from experiences working on various types of appeals cases.
- Played a key role in multiple successful audit reviews by maintaining meticulous records and upholding strict compliance standards in all appeal-related activities.
- Demonstrated exceptional attention to detail when evaluating medical records in order to identify discrepancies or inconsistencies that could impact an appeal''s outcome positively or negatively.
Customer Service Rep Sr/Claims
UnitedHealth Group
10.2006 - 08.2016
- Responsible for processing Medical, Vision, COLP, In-Patient and Out-Patient Hospital claims
- Responsible for various types of Correspondence with focus on Provider appeals and letters
- Help team members with claim issues when needed.
- Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Developed customer service policies and procedures to meet and exceed industry service standards.
Claims Analyst
TML-IEBP
04.1999 - 10.2006
- Responsible for processing Medical, Dental, Vision and Out Patient Hospital claims
- Handled simple adjustments
- Participated in Workflow and Policy & Procedure meetings
- Worked Pre & Post Duplicate reports with overpayment requests
- Help team members with claim issues when needed.
Claims Analyst
United Healthcare
04.1994 - 04.1999
- Responsible for processing Par Medical claims for the HMO division
- Reviewed all Medicaid claims for prior processing
- Handled Provider phone calls
- Backed up the main switch board.
Education
High School Diploma -
Richard King High School
Corpus Christi, TX06.1987
Skills
- Self-motivated
- Client assessment and analysis
- Accurate and detailed
- Maintains confidentiality
- Independent worker
- CPS Knowledge
- Experienced in Appeal Process
- Insurance Policies Understanding
- Data entry proficiency
- Teamwork and Collaboration
- Medical Terminology
- Claims adjustment
Timeline
Appeals Specialist
TML Health Benefits Pool , 1821 Rutherford Lane
08.2016 - 02.2023
Customer Service Rep Sr/Claims
UnitedHealth Group
10.2006 - 08.2016
Claims Analyst
TML-IEBP
04.1999 - 10.2006
Claims Analyst
United Healthcare
04.1994 - 04.1999
High School Diploma -
Richard King High School
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