Summary
Overview
Work History
Education
Skills
Timeline
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Stephanie Chapman

Stephanie Chapman

Harrisonville,MO

Summary

Results-driven Operations Service Manager and Senior Contract Specialist with extensive experience at UMR and GEHA, recognized for expertise in claims management and outstanding communication skills. Achieved excellence in resolving high-dollar claims while mentoring teams to improve process efficiency and elevate customer satisfaction. Strong organizational abilities combined with adept data analysis ensure precision and compliance in challenging environments.

Overview

27
27
years of professional experience

Work History

Operations Service Manager

UMR
09.2024 - Current
  • Liaison for complex customer base to manage initial response to escalated issues.
  • Managed tasks autonomously while handling diverse complex activities.
  • Exhibited extensive expertise in own function, with enhanced skills in coding and networks.
  • Proactively identifies non-standard requests and potential issues; investigates and resolves using established processes, expertise, and judgment.
  • Identify potential claim and / or customer service issues during implementation and create a plan to ensure risk is minimized.
  • Ensures accurate output by understanding source documents through coding, SAE, PNO, and network services.
  • Resolve operational challenges by applying defined processes along with specialized knowledge and judgment.
  • Resolved claim discrepancies and addressed customer service concerns effectively.
  • Organized and ensured accuracy of medical plan installation documents.
  • Responsible for testing customer benefit changes in claim processing system.
  • Maintain and enhance Health Plan Database.
  • Delivered remedial education to enhance processor and CSR performance.
  • Conducted in-depth reviews of extensive claim files to identify discrepancies and trends.
  • Oversaw high-value claims for stop-loss period.
  • Respond to SBA and external vendor audits.

Senior Contract Specialist

GEHA
04.1998 - 09.2024
  • Processed High-Dollar Claims: Efficiently handled and resolved high-dollar claims resulting from audit reviews by outside vendors and oversaw the preparation and presentation of high-dollar reports for management review, ensuring accuracy and clarity
  • Training and Mentorship: Provided training for new hires in Cost Management, Claims, and Customer Care and served as the designated specialist for job shadowing potential new hires
  • Invoicing Analysis and Reconciliation: Analyzed and reconciled invoicing for fees billed due to savings from outside vendors, ensuring financial accuracy and compliance
  • Procedure Creation and Updates: Collaborated with management and team members to create and update desk-level procedure guidelines
  • Interdepartmental Inquiries: Responded to inquiries from within GEHA, assisting in resolving member and provider questions promptly and accurately
  • Member/Provider Dispute Resolution: Managed and resolved disputes with members and providers in a timely and precise manner
  • Vendor Liaison: Acted as a liaison between GEHA and external vendors such as Zelis, Carewise, PMCS, Ceris, Lab Card, and MDLive, facilitating smooth communication and issue resolution
  • Pricing Information Requests: Obtained PPO pricing information from GEHA PPO networks, including Aetna and UHC
  • Correspondence Management: Created letters to members and providers as necessary, ensuring clear and effective communication
  • Customer Inquiry Handling: Answered customer questions about policies and procedures with a friendly and knowledgeable approach, ensuring high customer satisfaction
  • Issue Resolution: Investigated and resolved customer concerns related to order inquiries and delivery tracking efficiently

Education

High School Diploma -

Truman High School
Independence, MO
05.1996

Skills

  • Claims Management
  • Strong Interpersonal Communication
  • Data Analysis Skills
  • Effective Problem Resolution
  • Strong Organizational Abilities
  • Employee training and development

Timeline

Operations Service Manager

UMR
09.2024 - Current

Senior Contract Specialist

GEHA
04.1998 - 09.2024

High School Diploma -

Truman High School

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Stephanie Chapman