Christy Jones
LANSING
Summary
Dedicated member advocate achieving high member satisfaction through effective communication and problem-solving in health insurance. Skilled in HIPAA compliance, insurance verification, and medical terminology.
Overview
30
30
years of professional experience
Work History
Member Advocate
Blue Cross Blue Shield of Michigan
Lansing, MI
09.2024 - 05.2025
- Resolved member inquiries through efficient communication and problem-solving techniques.
- Facilitated onboarding processes for new members, ensuring compliance with organizational standards.
- Conducted follow-up calls to enhance member satisfaction and retention rates.
- Collaborated with team members to streamline service delivery and improve response times.
- Promoted a positive work environment through teamwork, open communication, and excellent customer service skills.
- Managed high call volumes while maintaining exceptional service quality and professionalism.
- Collaborated with cross-functional teams to resolve complex member concerns, ensuring satisfaction and loyalty.
- Resolved escalated member issues with diplomacy, tactfully navigating challenging situations while maintaining rapport with the customer.
- Developed strong relationships with members by providing personalized support and assistance.
- Provided comprehensive onboarding for new members, resulting in a seamless transition into the organization.
- Improved member satisfaction by promptly addressing inquiries and providing accurate information.
- Handled complaints with prompt, courteous service to uphold professional reputation.
- Verified customer identification and documentation for compliant transactions.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
Health Insurance Customer Service Representative
Blue Cross Blue Shield of Michigan
Lansing, MI
01.2004 - 09.2024
- Provided exceptional customer service by addressing inquiries and resolving issues promptly.
- Processed insurance claims efficiently, ensuring compliance with company policies and regulations.
- Educated clients on policy details, enhancing understanding of coverage and benefits.
- Collaborated with underwriters to assess risk factors and recommend appropriate coverage options.
- Conducted follow-up calls to ensure client satisfaction and retention of insurance policies.
- Managed high call volume while maintaining professionalism, empathy, and attention to detail in each interaction.
- Handled sensitive customer information with discretion, adhering to strict data privacy regulations at all times.
Grievance Appeals Specialist
Blue Cross Blue Shield of Michigan
Lansing, MI
12.1999 - 01.2004
- Facilitated communication between members, providers, and internal teams to resolve disputes efficiently.
- Analyzed complex grievance appeals to ensure compliance with regulatory guidelines and internal policies.
- Resolved escalated cases promptly and effectively, demonstrating strong negotiation skills when liaising with stakeholders.
- Enhanced grievance appeals efficiency by streamlining processes and implementing best practices.
- Collaborated with legal and compliance teams to address high-risk cases and mitigate potential organizational risks.
- Developed training materials to enhance staff understanding of grievance appeal processes and regulatory requirements.
- Contributed to higher client retention rates through exceptional service delivery during the grievance appeals process.
- Collaborated with cross-functional teams to address systemic issues identified during the grievance appeals process.
Customer Service Representative
Blue Cross Blue Shield of Michigan
Lansing, MI
12.1997 - 11.1999
- Resolved customer complaints efficiently to ensure satisfaction and retention.
- Assisted customers with inquiries regarding insurance plans and benefits.
- Processed claims and maintained accurate records in company database.
- Collaborated with team members to enhance service delivery processes.
- Handled high volumes of customer interactions through phone and email, maintaining professionalism at all times.
- Educated clients on coverage options and benefits, enhancing their understanding of insurance products.
- Processed policy applications and claims, ensuring compliance with company guidelines and industry regulations.
- Maintained up-to-date knowledge of insurance industry trends, adapting to changes in policies and procedures.
- Utilized CRM software to track customer communications and document case resolutions effectively.
- Answered incoming phone calls to articulate product value to prospective customers and support current policyholders.
- Assisted clients in filing claims, coordinating with adjusters to expedite the process and secure fair settlements.
- Fielded customer complaints, escalating complex issues to management for resolution.
- Fostered strong relationships with clients, providing personalized service and assistance on various insurance products.
- Educated customers on available discounts, promoting loyalty and policy retention through tailored recommendations.
- Provided exceptional support during annual open enrollment periods, guiding customers through plan selection processes effectively.
- Negotiated solutions between policyholders and company, finding common ground for disputes.
- Led team project to identify common customer issues and develop proactive solutions.
- Acted promptly to customer complaints, significantly reducing escalation rates.
- Enhanced customer experience by accurately addressing and resolving diverse range of insurance queries.
- Increased customer retention by offering tailored insurance solutions based on individual needs.
Marketing Administrative Clerk
Blue Cross Blue Shield of MI
Lansing, MI
04.1996 - 12.1997
- Developed targeted marketing campaigns to enhance brand awareness and engagement.
- Collaborated with cross-functional teams to execute promotional events, enhancing brand visibility and engagement.
- market research to identify trends and inform strategic decisions.
- Produced and formatted documents with attention to detail for internal and external communications.
- Processed data entries to ensure timely and precise reporting. Processed system changes to generate accurate reports.
- Trained new clerical staff on office procedures and software applications for improved performance.
- Safeguarded sensitive information by maintaining strict confidentiality protocols when handling personnel files or company documentation.
Provider Inquiry Clerk
Blue Cross Blue Shield of Michigan
Grand Rapids, MI
10.1995 - 04.1996
- Responded to customer inquiries promptly, delivering accurate information and support to enhance customer satisfaction.
- Utilized internal systems to track claims and facilitate resolution efforts, contributing to improved service outcomes.
- Processed member applications and updates efficiently within established timelines.
- Managed records and documentation to ensure compliance with regulations, supporting organizational integrity.
Education
No Degree - Marketing Management
Lansing Community College
Lansing, MISkills
- Coverage assessment
- Patient privacy regulations
- Medical terminology
- Patient advocacy
- Benefits analysis
- Problem-solving
Timeline
Member Advocate
Blue Cross Blue Shield of Michigan
09.2024 - 05.2025
Health Insurance Customer Service Representative
Blue Cross Blue Shield of Michigan
01.2004 - 09.2024
Grievance Appeals Specialist
Blue Cross Blue Shield of Michigan
12.1999 - 01.2004
Customer Service Representative
Blue Cross Blue Shield of Michigan
12.1997 - 11.1999
Marketing Administrative Clerk
Blue Cross Blue Shield of MI
04.1996 - 12.1997
Provider Inquiry Clerk
Blue Cross Blue Shield of Michigan
10.1995 - 04.1996
No Degree - Marketing Management
Lansing Community College