STACY SHRIEVES
Denton,TX
Summary
Detail-oriented customer service representative with a strong focus on problem-solving and multitasking. Proven ability to assist customers by gathering accurate information and providing effective solutions. Experienced in managing records and ensuring efficient service delivery. Committed to enhancing customer satisfaction through attentive support and clear communication.
Overview
9
9
years of professional experience
Work History
Claims Examiner
Auxiant
06.2025 - 04.2026
- Processed and adjudicated self-funded medical claims while managing member/provider correspondence via phone and email.
- Handled customer service calls and tickets for assigned groups, addressing high dollar and priority claims, and resolving claim edits.
- Reviewed insurance claims for accuracy and compliance with company policies.
- Investigated claim disputes and gathered necessary documentation for resolution.
- Communicated with clients and providers to clarify information and resolve issues.
Claims Examiner
Teksystem
06.2024 - 06.2025
- Processed and analyzed self-funded medical claims while managing member/provider correspondence via phone and email.
- Managed customer service calls to address client needs and processed service tickets efficiently.
- Evaluated claims for accuracy and compliance with regulatory standards.
- Reviewed documentation to determine claim eligibility and payment amounts.
- Collaborated with healthcare providers to verify patient information and services rendered.
Members Advocate
DVS
12.2023 - 06.2024
- Addressed complex challenges with innovative solutions to enhance member support.
- Utilized web-based platforms and active listening skills to understand customer needs, clarify information, and provide tailored solutions.
- Research complex issues pertaining to the caller's health, status and potential plan options.
- Navigate across multiple databases, respond to and resolve on the first call, customer service inquiries and issues by identifying the topic and type of assistance the caller is needing- such as benefits, eligibility claims, and financial spending accounts for medical and pharmacy claims and or benefits.
- Coordinated with care providers to facilitate appointment scheduling for members.
Claims Processor 1,2
Wisconsin Physicians Service Insurance Corporation (WPS)
10.2017 - 10.2023
- Military and Veterans Health (MVH) claims from receipt through resolution in accordance with MVH regulations, guidelines, and quality standards, with expertise in coordination of benefits (COB), eligibility, and claims development.
- Analyze claims to determine if eligibility requirements and claim filing requirements are met and make determinations.
- Calculate Other Health Insurance (OHI) COB amounts using the data from claim such as the EOB or prior payment information given.
- Identified and escalated cases to relevant departments during claim processing.
- Processed all claim types by determining and implementing corrective actions on various system-pended errors and resolving interactive edits.
- Reviewed submitted claim information to accurately select procedure and diagnosis codes using ICD-10, CPT4, and HCPCS manuals.
Customer Service Representative
HSN
09.2022 - 05.2023
- Identified and resolved customer problems efficiently, while providing additional support to enhance overall satisfaction.
- Assisted customers with inquiries, ensuring a positive experience during each interaction.
- Confirmed refunds, processed payments, placed orders, and analyzed account data to support customer needs.
- Take payments via credit card or bank account or using HSN card, QVC card.
- Answer high volume of inbound customer calls, work from home.
Education
GED -
Richard Arnold
Savannah, GASome College (No Degree) - Microsoft Office Training
Family Investment Center
Newport News, VASome College (No Degree) - Business Administration
Everest Community College
Newport News, VASkills
- Conflict resolution
- Client relations and engagement
- Client consultation
- Customer service support
- Verbal communication
- Effective communication
- Active listening
- Attention to detail
- Data entry accuracy
- Time management
- Team collaboration
- Adaptability
- Microsoft Office proficiency
- Report preparation
- Decision-making skills
- Complex problem solving
- Documentation review
- Regulatory compliance
- Customer support and management
- Database management
- Live chat support
- Written communication skills
- Multi-line telephone operations
- Typing speed 40 wpm
- Follow-up skills
- Professional telephone demeanor
- Empathy and patience
- Reading comprehension
Volunteer Experience
- Grace House (Shelter), Savannah, GA, 1995
- Child Support Office, Savannah, GA, 1995
Timeline
Claims Examiner
Auxiant
06.2025 - 04.2026
Claims Examiner
Teksystem
06.2024 - 06.2025
Members Advocate
DVS
12.2023 - 06.2024
Customer Service Representative
HSN
09.2022 - 05.2023
Claims Processor 1,2
Wisconsin Physicians Service Insurance Corporation (WPS)
10.2017 - 10.2023
GED -
Richard Arnold
Some College (No Degree) - Microsoft Office Training
Family Investment Center
Some College (No Degree) - Business Administration
Everest Community College