Patient Services Specialist with Claims Expertise

Chelsea Shane

Key Skills

Advanced knowledge of

Microsoft Products

Excellent oral and written

communication

Experienced case

management skills

Organized, diligent and driven

Professional Summary

Over three years of experience as a Patient Services Representative at Quantum Health, supporting care coordination and member engagement. Familiarity with weight management programs and medication coordination, including GLP-1 prescribing workflows. Strong background in customer service and communication with members, providers, and external vendors. Skilled in managing multiple workflows and tasks simultaneously, ensuring timely documentation and compliance with healthcare standards. Proficient in Microsoft Office Suite, Teams, Zoom, and other administrative tools for effective coordination and reporting. Demonstrated ability to collaborate with cross-functional teams and external consultants to support product evolution and enhance member satisfaction. Education

2012

Bachelor of Arts in Psychology

Florida Gulf Coast University

References

Sarah Jorgensen

Velia Peiz

Experience

June 2021—Present

PSR • Quantum Health • Dublin, Ohio

● Transitioned from Patient Service Representative (PSR) to Electronic Patient Service Representative (EPSR), expanding responsibilities from phone-based support to digital communication through secure messaging and live chat.

● Selected for a stretch assignment to resolve complex claim issues for a key client, ensuring high-cost claims are processed accurately per plan language to prevent inappropriate denials and minimize member impact.

● Work late-night shifts, gaining deep familiarity with various third-party administrators (TPAs) and group-specific plan nuances to assist members with fewer available resources.

● Trained under the pod’s Claim Specialist to provide backup support during absences, ensuring timely resolution of claim issues and continuity of service.

December 2015—July 2016

Case Manager • St. Matthew’s House • Naples, Florida

● Managed a diverse caseload of clients navigating recovery from substance use disorders, supporting them through sobriety and community reintegration.

● Coordinated individualized treatment plans, connecting clients with addiction recovery programs, mental health services, and vocational training.

● Conducted comprehensive intake assessments for new clients entering the homeless shelter, identifying immediate needs and long-term goals.

● Provided consistent case management, including goal tracking, crisis intervention, and referrals to housing, employment, and healthcare services.

● Maintained accurate, confidential documentation in compliance with HIPAA and agency policies. May 2012—December 2015

Case Manager, Intake Coordination, Behavioral Technician • David Lawrence Center • Naples, Florida Case Manager

● Supported clients recently released from jail in their transition back into the community, addressing mental health, housing, employment, and substance use challenges.

● Developed individualized treatment and reintegration plans, connecting clients with therapy, job placement, housing, and peer support services.

● Collaborated with probation officers, treatment providers, and community organizations to monitor progress and reduce recidivism.

● Advocated for clients in legal, housing, and healthcare settings to ensure access to essential services. Intake Coordinator

● Conducted comprehensive safety assessments for individuals in mental health or substance use crises.

● Determined level of care needed, including referrals to inpatient behavioral units, detox facilities, or outpatient support.

● Maintained detailed intake records in compliance with legal and ethical standards.

● Provided immediate support and resources to individuals and families during acute psychological distress. Behavioral Health Technician

● Delivered direct care and supervision for clients in crisis, supporting recovery and safety in inpatient and residential settings.

● Assisted with crisis de-escalation, daily living skills, medication monitoring, and therapeutic activities.

● Observed and documented client behaviors, reporting critical updates to the clinical team.

● Built strong rapport with clients to encourage treatment, participation and emotional regulation.

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