Marcella Marshall
Winston-Salem,NC
Summary
I'm a personable and dedicated Advocate with extensive experience in Service. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Advocate known for high productivity and efficient task completion. Specialize in conflict resolution, effective communication, and customer relationship management. Excel in active listening, problem-solving, and adaptability to ensure positive outcomes in customer interactions.
Overview
11
11
years of professional experience
Work History
Appeal and Grievance Auditor
Blue Cross NC
Winston -Salem, NC
02.2023 - 05.2025
- Handle complaints/grievances as defined by the federal government
- Investigate member and provider appeals and grievances for all lines of business
- Identify, collect, and analyze appropriate documentation from multiple internal systems including claims, customer contract management, benefit booklets, UM systems, coding claim edits, and external sources including pharmaceutical companies, attorneys, providers
- Medicare, PBMs, etc
- Consult with medical directors and other clinical staff to ensure the appropriate decision has been made and the approved outcomes are implemented
- Research and provide determinations on medication appeals for Part D members, and Part C appeals
- Answer member/provider questions via incoming telephone calls in a professional quality driven manner
- Provide written documentation of case determinations to appellants and/or all involved parties (including but not limited to physicians, attorneys, senators/legislators, employer groups, etc.) in a timely manner as required by regulatory mandates and legislation
Customer Service Advocate
Blue Cross Blue Shield
Winston-Salem, NC
10.2016 - 02.2016
- Supporting Member Inventory Team in all Lines of Business ASO, PG/Dedicated/U-65, IPP
- Utilize probing, research, and problem-solving skills to help resolves members issues or concerns
- Document corrective measures and provide instructions as needed to internal business areas to ensure prompt resolution and response to customer needs
- Work collaboratively with Sales, Healthcare and Network Management to identifying opportunities to promote programs
- Complete and finalize members inquiries in timely manner
- Handled escalated calls for front-line associates to address complex issues and restore customer satisfaction
- Monitored trends and recommended customer service improvements to enhance team success.
- Assisted management with the development of new strategies for improved customer satisfaction.
- Performed follow-up procedures after customer service interaction was completed.
Customer Service Professional
Blue Cross Blue Shield of North Carolina
Winston-Salem, NC
08.2014 - 10.2016
- Educate customers and providers on acceptable BCBSNC practices and policies
- Identify, understand customers' unexpressed needs and concerns in a caring manner
- Perform phone/email outreach to BCBSNC vendors and business partners to resolve service issues
- Committed to the vision providing exceptional customer service to all providers and members
- Collaborated with other departments to resolve customer inquiries quickly and effectively.
- Informed customers about billing procedures, processed payments and provided payment option setup assistance
- Met and exceeded productivity targets by handling every interaction with top-notch customer service.
Appeals Analyst
Alliance Health
Morrisville, NC
05.2025 - Current
- Collaborated with clinical teams to gather necessary documentation for appeal processes.
- Analyzed appeals cases for compliance with healthcare regulations and policies.
- Reviewed denial letters to identify trends and recommend improvements in procedures.
- Analyzed and evaluated appeals to ensure compliance with applicable laws, regulations, policies and procedures.
- Communicated effectively with patients regarding their appeal status and next steps.
- Conducted research on evidence submitted in support of appeals.
Education
Bachelor of Arts - Gerontology
Winston Salem State University
Winston-Salem, NCSkills
- Efficient and Detail-Oriented
- Understanding Customer Needs
- Creative Problem Solving
- De-escalation Techniques
- Issue and Complaint Resolution
- Identifying Compliances Issues
- Call Documentation
- Multitasking and Prioritization
- Problem-Solving Abilities
- Database Management
- Compliance standards
- Regulatory Compliance
- Issue Resolution
- Internal Auditing
Additional Information
Authorized to work in the US for any employer
References
References available upon request.
Timeline
Appeals Analyst
Alliance Health
05.2025 - Current
Appeal and Grievance Auditor
Blue Cross NC
02.2023 - 05.2025
Customer Service Advocate
Blue Cross Blue Shield
10.2016 - 02.2016
Customer Service Professional
Blue Cross Blue Shield of North Carolina
08.2014 - 10.2016
Bachelor of Arts - Gerontology
Winston Salem State University