Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Shantel Helus

Thornton

Summary

To utilize my bookkeeping, accounting, professional customer service experience in a call center environment, inputting skills and computer skills in a position that will allow me to assist others and grow with the company.

Overview

28
28
years of professional experience

Work History

Grievances and Appeals Analyst II

Anthem Blue Cross Blue Shield
03.2022 - Current
  • Analyzed complex appeals to ensure compliance with regulatory standards and internal policies.
  • Developed detailed reports on appeal trends to inform strategic decision-making processes.
  • Collaborated with cross-functional teams to resolve disputes and improve case outcomes.
  • Trained new staff on best practices for handling appeals, enhancing team efficiency and accuracy.

Grievances and Appeals Analyst I

Anthem Blue Cross Blue Shield
02.2019 - 03.2022
  • Analyzed and resolved complex appeals, ensuring compliance with regulatory requirements and company policies.
  • Collaborated with cross-functional teams to streamline appeal processes, enhancing operational efficiency.
  • Conducted in-depth research on case files, identifying critical information to support decision-making.
  • Trained and mentored junior analysts on best practices for managing appeals and documentation standards.
  • Developed comprehensive reports summarizing appeal outcomes to inform strategic improvements and policy adjustments.
  • Implemented process improvements that reduced turnaround times for appeal resolutions while maintaining accuracy.
  • Facilitated communication between members, providers, and internal departments to resolve disputes effectively.

Member Service Representative

Anthem Blue Cross Blue Shield
09.2013 - 02.2019
  • Resolved member inquiries and concerns through effective communication and problem-solving techniques.
  • Provided guidance on benefits, coverage options, and claims procedures to enhance member understanding.
  • Facilitated enrollment processes for new members, ensuring accurate data entry and compliance with policies.
  • Collaborated with cross-functional teams to streamline service processes and improve member satisfaction rates.

Collection Specialist

TransFirst LLC
03.2008 - 02.2012
  • Managed collections processes to reduce outstanding balances and improve cash flow.
  • Analyzed account discrepancies and developed resolutions to expedite payment recovery.
  • Coordinated with clients to negotiate payment plans, enhancing customer relationships and retention.
  • Utilized CRM systems to track accounts and monitor collection progress effectively.
  • Trained junior team members on best practices for collections strategies and compliance regulations.
  • Implemented process improvements that streamlined workflow and increased overall team efficiency.
  • Led initiatives to assess credit risk, ensuring responsible lending practices across the organization.
  • Conducted regular audits of accounts to maintain accuracy and compliance with industry standards.
  • Worked in call center environment handling manual and automatically dialed outbound calls.
  • Negotiated to collect balance in full.
  • Improved customer payment compliance through negotiating mutually agreeable repayment plans.
  • Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
  • Processed payments and applied to customer balances.

Retrieval/Chargeback/Arbitration Specialist

TransFirst LLC
11.1998 - 03.2008
  • Developed strategies to enhance customer engagement and improve service delivery efficiency.
  • Collaborated with cross-functional teams to streamline processes and eliminate redundancies.
  • Optimized inventory management, minimizing waste and reducing costs.

Bank Teller/Cash Management/Cash Control/Cashiering

1st Bank
05.1998 - 11.1998
  • Processed customer transactions accurately and efficiently, ensuring high levels of service satisfaction.
  • Managed cash handling procedures, maintaining compliance with bank policies and regulations.
  • Assisted customers with account inquiries, providing timely information and solutions to enhance their banking experience.

Education

Associates Degree - Paralegal Studies

Parks Junior College
Thornton, Co
05-2000

High School Diploma -

Holy Family Catholic High School
Broomfield, Co
01-1998

Skills

  • Administrative support
  • Claims analysis
  • Dispute resolution
  • Administrative expertise
  • Regulatory compliance
  • Co-worker assistance

Accomplishments

  • Mastered various computer applications, including Microsoft word, Outlook, Excel, Adobe, Accounting software, database programs, CCB Phone, Mainframe, MCC Companion and WDE, Nextgen, and other various applications. Business machines include fax machines, copy machines and 10 key calculator, customer service duties, sorting and processing incoming mail and corporate headquarters receptionist.
  • Preparation of daily, weekly and monthly collection reports.
  • Provided customers with new information and products available to better serve and enhance their businesses.
  • Created and prepared correspondence to customer clientele, attended and prepared meeting notes.
  • Communicated with inter-departmental staff, supervisors and merchants in a personable and professional manner.
  • Developed and fostered an excellent working relationship with clientele, banks and other financial institutions.
  • Trained co-workers and interdepartmental staff in customer service and provided problem solving techniques in dealing with and assisting with problematic issues.
  • Crossed trained in all aspects of the business, CA Large Group, Colorado/Nevada, PG30, Dedicated and AHG.
  • Learned to work the CU, Colorado/Nevada CPD, aging reports along with the CU denial reports and AHG Adherence Report.
  • Successfully completed AHG training as trailblazer for the new team and cross-trained with established National AHG representatives.
  • Went through appeals and grievance training as well as side by side with a grievance representative, claims training and e-learning training.
  • Have been assigned time sensitive tasks and have completed them before the scheduled deadlines.
  • Have and continue to assist with inventory for representatives that are no longer with Anthem or need assistance with their inventory and with the COB queue.
  • My daily tasks include working time sensitive case files which have to be confidential, cannot discuss personal information with anyone outside of work, completing and sending letters out to members and other parties.

Timeline

Grievances and Appeals Analyst II

Anthem Blue Cross Blue Shield
03.2022 - Current

Grievances and Appeals Analyst I

Anthem Blue Cross Blue Shield
02.2019 - 03.2022

Member Service Representative

Anthem Blue Cross Blue Shield
09.2013 - 02.2019

Collection Specialist

TransFirst LLC
03.2008 - 02.2012

Retrieval/Chargeback/Arbitration Specialist

TransFirst LLC
11.1998 - 03.2008

Bank Teller/Cash Management/Cash Control/Cashiering

1st Bank
05.1998 - 11.1998

Associates Degree - Paralegal Studies

Parks Junior College

High School Diploma -

Holy Family Catholic High School
Shantel Helus