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
Canton, MA
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
Holyoke, MA
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
Springfield, MA
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 MASkills
- 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.