Summary
Overview
Work History
Education
Skills
Timeline
I am a Coach for Special Olympics
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Stephanie Peabody

West Springfield

Summary

Dynamic Appeals and Grievance Specialist at Point32 Health Insurance with a proven track record in complaint handling and dispute resolution. Enhanced client trust through empathetic communication while reducing case backlog. Skilled in problem-solving and time management, consistently meeting performance metrics and ensuring compliance with regulations.

Overview

10
10
years of professional experience

Work History

Appeals and Grievance Specialists

Point32 Health Insurance
08.2021 - 04.2025
  • Consistently met performance metrics such as quality scores and case closure rates, demonstrating commitment to excellence in handling customer grievances.
  • Reduced case backlog by prioritizing urgent grievances and implementing efficient workflows.
  • Enhanced client trust through empathetic communication and thorough investigation of grievances.
  • Implemented regular audits of grievance processes, identifying areas for improvement and maintaining compliance with regulations.
  • Reviewed, processed, and resolved member and provider appeals and grievances in compliance with CMS and NCQA regulations.
  • Investigated complex claims and coordinated with clinical and operational teams to evaluate medical necessity and coverage decisions.
  • Maintained compliance with turnaround time requirements and quality assurance benchmarks.
  • Participated in internal audits and process improvement initiatives to enhance team performance and member satisfaction.
  • Utilized a variety of systems and tools including MedHok, SharePoint, MicrosoftTeams, HRP, Diamond, PaySpan, and Market Prominence to manage case workflows and documentation.



Data Entry Coordinator

ES Sports
01.2020 - 03.2020
  • Maintained high levels of focus, entering large volumes of data accurately within tight deadlines.
  • Collaborated with cross-functional teams to ensure timely and accurate data input for various projects.
  • Optimized data storage by categorizing records according to established procedures and guidelines.
  • Enhanced data accuracy by meticulously reviewing and verifying entered information.

Customer Care Representative and Inside Sales

Hurley and David
03.2015 - 10.2019
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
  • Managed high call volume with exceptional professionalism and efficiency.
  • Responded to customer needs through competent customer service and prompt problem-solving.
  • Assisted call-in customers with questions and orders.
  • Maintained a high level of product knowledge to provide accurate information and support to customers.
  • Built rapport with customers through active listening and empathetic responses, fostering positive relationships.
  • Enhanced customer satisfaction by promptly addressing inquiries and resolving issues.
  • Streamlined call response times for improved customer experience through effective communication techniques.
  • Increased sales revenue by building strong relationships with clients and providing insightful product recommendations.
  • Collection Calls for Payment - Residential and Commerical Accounts.

Education

Associate of Science - Business Management

Holyoke Community College
Holyoke MA

Skills

  • Complaint handling
  • Dispute resolution
  • Mediation techniques
  • Trade policy
  • Teamwork and collaboration
  • Problem-solving
  • Time management
  • Multitasking skills
  • Attention to detail

Timeline

Appeals and Grievance Specialists

Point32 Health Insurance
08.2021 - 04.2025

Data Entry Coordinator

ES Sports
01.2020 - 03.2020

Customer Care Representative and Inside Sales

Hurley and David
03.2015 - 10.2019

Associate of Science - Business Management

Holyoke Community College

I am a Coach for Special Olympics

I have been a Coach for Special Olympics for 15 years. I coach Softball, Basketball and help with Flag Football. Special Olympics is very rewarding and I am so glad that I took this journey with them.

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Stephanie Peabody