Stephanie Shell
St Louis,MO
Summary
Dedicated Claims and Customer Service Specialist versed in insurance and applying strong communication, problem-solving skills and polite, professional demeanor to resolve customer issues and maximize satisfaction. Experienced in exceeding performance goals in fast-paced work environments. Trained in connecting with customers to build positive relationships and strengthen loyalty.
Overview
13
13
years of professional experience
Work History
Senior Claims Adjuster, Automobile and Casualty
Progressive Insurance
09.2023 - 06.2024
- Stayed current on industry trends and state regulations to ensure compliance in all aspects of claim handling.
- Recognized for maintaining a high level of customer service while managing a large volume of claims simultaneously, exceeding performance expectations.
- Coordinated with customers, appraisers, repair shops, and other experts as needed for comprehensive claim evaluations.
- Improved interdepartmental communication by establishing regular meetings between claims staff and underwriting teams to discuss risk assessment strategies and policy recommendations.
- Maintained a high level of accuracy in claim payments by thoroughly reviewing invoices and verifying coverage details before approval.
Medical Assistance Specialist 3
WA State Health Care Authority
10.2019 - 05.2023
- Independently analyze applications, determine initial and/or ongoing eligibility and authorize benefits for Medicaid programs administered by the Medical Eligibility Determination Services (MEDS) office
- Use and manage multiple interdependent electronic systems including but not limited to the Automated Client Eligibility System (ACES), HealthPlanFinder, ProviderOne, Audit Plus, Microsoft Office, SOLQ, Document Management System (DMS) and Employment Security Department (ESD)
- Answer inquiries, resolve questions, process claims, update eligibility records, and otherwise maintain and expand access to medical care for eligible Washington citizens
- Work in partnership with advocates, providers, Heath Benefit Exchange, other state agencies, community-based organizations, and other units within HCA to provide clarification, resolve disputes, solve problems, coordinate referrals and/or answer inquiries.
Contact Center Agent/Customer Service
UW Medicine
07.2017 - 12.2017
- Answered incoming phone calls from customers and identify the type of assistance the customer needs (i.e
- Benefit and eligibility, billing and payments, claims, authorizations for treatment and explanation of benefits (EOBs)
- Resolved issues on behalf of the customer in real time or through comprehensive and timely follow researched complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
- Provided education and status on previously submitted pre-authorizations or predetermination requests
- Exceeded the performance goals established for efficiency, call quality, caller satisfaction, first call resolution and attendance.
Customer Service Agent/Utilization Management
Anthem Inc
03.2013 - 06.2017
- Answered inbound calls from Providers and Members regarding eligibility, medical claims, referrals and benefits
- Managed high-volume of inbound and outbound customer and provider calls
- Utilized active listening and communication skills to address customer inquiries and escalate issues to supervisor
- Reviewed files, records and other obtained documents to respond to customer requests.
UnitedHealth Group
UnitedHealth Group
08.2011 - 11.2013
- Answered inbound calls from Medicare Elderly and Retired members regarding their Medicare and/or Medicaid account
- Explained eligibility details and affordability options to patients with kindness and respect
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
Education
Associate in Arts degree, General Transfer Studies -
Saint Louis Community College
Medical Assistance -
Missouri College
St. Louis, MO01.2006
Skills
- Customer Service
- Claims Processing
- Customer Data Confidentiality
- Insurance
- Customer Complaint Resolution
- Call Center Operations
State
FL
Zip
33573
City
Sun City Center
Timeline
Senior Claims Adjuster, Automobile and Casualty
Progressive Insurance
09.2023 - 06.2024
Medical Assistance Specialist 3
WA State Health Care Authority
10.2019 - 05.2023
Contact Center Agent/Customer Service
UW Medicine
07.2017 - 12.2017
Customer Service Agent/Utilization Management
Anthem Inc
03.2013 - 06.2017
UnitedHealth Group
UnitedHealth Group
08.2011 - 11.2013
Associate in Arts degree, General Transfer Studies -
Saint Louis Community College
Medical Assistance -
Missouri College
Similar Profiles
Accassia HamAccassia Ham
Processor at Progressive InsuranceProcessor at Progressive Insurance
Nicolas LacentraNicolas Lacentra
Large Loss Adjuster at Progressive InsuranceLarge Loss Adjuster at Progressive Insurance
Michael CamposMichael Campos
Managed Repair Supervisor at Progressive InsuranceManaged Repair Supervisor at Progressive Insurance
Julie HayduJulie Haydu
Claims Auditor IV With AIC Responsibilities at Progressive InsuranceClaims Auditor IV With AIC Responsibilities at Progressive Insurance
John SchraderJohn Schrader
Senior Director at Cushman & WakefieldSenior Director at Cushman & Wakefield