Kristen B.

Key Skills

Software

Other

Top Subject Matter

Healthcare appeals and grievances (Medicare/Medicaid member disputes)

Healthcare grievances (CMS/plan-policy compliance)

Healthcare provider appeals and dispute resolution (CMS/contract compliance)

Top Data Types

Document

Image

Text

Top Task Types

Text Generation

Classification

Freelancer Overview

Letter Writer (Grievance decision letters for TMG Health). Brings 15+ years of professional experience across complex professional workflows, research, and quality-focused execution. Core strengths include Other, Internal, and Proprietary Tooling. Education includes High School Diploma, Pittston Area Senior High School (2011). AI-training focus includes data types such as Document and labeling workflows including Text Generation and Classification.

Labeling Experience

Letter Writer (Grievance decision letters for TMG Health)

OtherDocumentText Generation

Reviewed grievance casework documents to determine member dissatisfaction and ensure cases were resolved with accurate, complete information. Composed written decision letters based on grievance coordinator-provided case details, producing final textual responses for members. Ensured all processing and documentation met internal requirements and relevant federal guidance where applicable. • Investigated grievance information to identify the underlying complaint • Compiled pertinent case details into written correspondence • Produced resolutions/decisions communicated in letters • Verified completeness and correctness of files for case closure

2021 - Present

Appeals and Grievance Coordinator

DocumentClassification

Processed and identified grievances in accordance with CMS guidelines and plan policies, ensuring each case was correctly categorized for handling. Investigated relevant information and prepared written notification responses for members. Logged grievances in internal systems while maintaining accurate, complete records and meeting federal timeframes. • Identified and routed grievances for appropriate processing • Investigated case facts and prepared written notifications • Communicated with members to obtain needed information • Maintained compliance through timely completion and accurate system logs

2019 - 2021

Provider Resolution Specialist

DocumentClassification

Handled provider disputes/appeals by ensuring each case was appropriately identified and processed under CMS guidelines and client service levels. Investigated relevant information and prepared written notification responses communicating outcomes to stakeholders. Ensured compliance with contracts and applicable laws while logging appeals in internal systems and maintaining complete case files. • Identified disputes/appeals for correct downstream processing • Conducted investigations to support written outcomes • Authored stakeholder notification responses • Logged appeals and maintained accurate documentation

2018 - 2019

Appeals and Grievances Coordinator

DocumentClassification

Ensured grievances were identified and processed in accordance with CMS guidelines and plan policies. Investigated relevant information, prepared written notification responses, and communicated with members to obtain needed details. Maintained compliance by completing cases within required timeframes and logging grievances in appropriate internal systems. • Identified and processed grievance cases for compliance • Investigated case facts and produced written notifications • Gathered member information to support outcomes • Maintained accurate internal logs and complete case files

2017 - 2018

Education

Work History