Megan Wilborn
Trenton,GA
Summary
Talent-minded operations leader with 13+ years of experience at BlueCross BlueShield of Tennessee and a strong background in workforce planning, hiring strategy, candidate selection, leadership development, and organizational effectiveness. Trusted partner with Human Resources and senior leaders, supporting hiring decisions, interview strategy, and talent development across frontline, leadership, and specialized business roles. Skilled for using data to guide decisions, solve complex staffing challenges, influence decisions, and build strong, long-term partnerships. Experienced with Workday, Microsoft Copilot, and workforce technologies, with a practical, people-first approach focused on positive candidate and employee experience.
Overview
18
18
years of professional experience
Work History
Manager of Operations: MA Customer Service
BlueCross BlueShield of Tennessee
05.2024 - Current
- Lead a multi-level Medicare Advantage Customer Service organization of 100+ Customer Service Representatives, 11 Technical Team Experts, and 5 Supervisors, balancing staffing, service, quality, compliance, member experience, and employee engagement priorities.
- Lead workforce planning, staffing strategies, hiring, onboarding, and employee development to support operational readiness and sustainable growth.
- Partner with Human Resources and senior leadership on candidate review, interviews, hiring decisions, talent development, and leadership planning.
- Provide consultative guidance to leaders on staffing needs, workforce readiness, performance trends, succession planning, and organizational priorities.
- Leverage workforce analytics, performance metrics, and operational trends to identify gaps, influence decisions, and develop practical solutions.
- Build trust-based partnerships across Medical Management, Appeals, Utilization Management, Workforce Management, Training, Quality, and other business areas.
- Identify and develop high-potential employees for advancement opportunities and support internal talent mobility through mentoring, coaching, and leadership development.
- Drive process improvements and strategic initiatives that improve efficiency, reduce risk, strengthen employee experience, and support member-focused outcomes.
- Leverage Workday, Microsoft Copilot, and Microsoft 365 tools to support talent processes, analysis, communication, and operational planning.
Operations Supervisor: Medicare Advantage Customer Service
BlueCross BlueShield of Tennessee
07.2018 - 05.2024
- Led, coached, and developed a team of Medicare Advantage Customer Service Representatives while maintaining focus on service quality, accountability, and employee growth.
- Participated in candidate interviews and selection decisions for frontline and leadership opportunities, with emphasis on job fit, communication, service mindset, and long-term potential.
- Trained and onboarded newly promoted Customer Service Supervisors and supported leadership readiness through practical coaching and knowledge sharing.
- Identified high-potential employees and recommended development opportunities to support succession planning and internal advancement.
- Partnered across Medical Management, Case Management, Appeals, Utilization Management, and other operational teams to solve complex business and staffing challenges.
- Created job aids, training resources, and virtual meeting standards that improved clarity, consistency, and employee experience in a remote environment.
- Led process improvement and employee engagement initiatives, including workshops, cross-functional workgroups, Employee Appreciation Week, and team learning activities.
Supervisor Clinical Support: Medicare Advantage Utilization Management
BlueCross BlueShield of Tennessee
12.2016 - 07.2018
- Led the clinical support team responsible for timely and accurate support of Medicare Advantage Utilization Management cases.
- Monitored productivity, resource needs, and workflows, using data and time studies to improve staffing decisions, turnaround times, and team effectiveness.
- Partnered with Customer Service, Appeals, EPI, Medical Management, and vendor teams to redesign processes and implement practical, cross-functional solutions.
- Launched and evaluated pilot programs, including PACday and discharge data outreach efforts, to improve efficiency and workload management.
- Developed training materials, workflows, scripts, and soft-skills guidance for pre-service staff, Review Analysts, and Medical Directors.
- Led employee engagement and communications efforts, mentored employees, and provided structured feedback to support development and performance.
Technical Team Expert: Medicare Advantage Customer Service
BlueCross BlueShield of Tennessee
04.2015 - 12.2016
- Provided specialized technical and process support to Customer Service Representatives on complex member inquiries, claims, benefits, prior authorization, and system-related questions.
- Developed a comprehensive quick-reference guide and delivered training to improve employee knowledge, service consistency, and operational readiness.
- Partnered with Medical Management to streamline the Single Patient Agreement process and improve the experience for both employees and members.
- Organized TTE meetings and coordinated schedules to strengthen coverage, communication, and collaboration.
Customer Service Representative: Medicare Advantage Customer Service
BlueCross BlueShield of Tennessee
02.2013 - 04.2015
- Delivered member-first service in a highly regulated Medicare Advantage environment, building a strong foundation in communication, problem-solving, systems, and healthcare operations.
Nanny
Drs. Clifton and Erin Reade
01.2009 - 02.2013
Education
Associate of Applied Science -
Chattanooga State Technical Community College
Chattanooga05-2025
LPN Program -
Chattanooga State Technical Community College
Chattanooga, TN05-2011
Certified Healthcare Customer Service Associate
America's Health Insurance Plans (AHIP)10-2022
Lean Six Sigma Green Belt
06-2018
Lean Six Sigma Yellow Belt
03-2016
Core Strengths
- Workforce Planning & Talent Strategy
- Full-Cycle Hiring & Candidate Selection
- Behavioral Interviewing
- Leadership & Supervisor Recruitment
- Talent Assessment & Selection
- Strategic Business Partnership
- Data-Driven Decision Making
- Employee Engagement & Retention
- Workday & Recruiting Technologies
- AI Tools including Microsoft Copilot
- Stakeholder Influence
- Training, Mentoring & Leadership Development
Technology
- Workday
- Microsoft Office 365 (Word, Excel, PowerPoint, TEAMs, Access, etc.)
- Paradox
- Keylight
- Facets and Agent Workspace
- Genesys Cloud
- Various Telephony and Reporting Applications
- Performance Dashboard (EOPD)
- P8 Imaging
- CareAdvance
Selected Talent & Workforce Leadership
• Lead workforce planning, staffing, hiring, onboarding, and talent development for a multi-level customer service organization of 100+ representatives, 11 Technical Team Experts, and 5 Supervisors.
• Partner with Human Resources and senior leaders on candidate review, interview strategy, selection decisions, staffing needs, and organizational readiness.
• Use workforce data, performance trends, and operational needs to guide hiring decisions, identify talent gaps, and support long-term staffing plans.
• Identify and develop high-potential talent for leadership opportunities, including mentoring, onboarding new supervisors, and supporting succession planning.
• Use Workday, Microsoft Copilot, and other business technologies to support hiring activities, improve communication, organize information, and strengthen decision-making.
Accomplishments
- Earned the highest employee engagement survey results in Customer Service for 5 consecutive years.
- Served as an Achievers in Motion (AIM) mentor in 2024 and 2025.
- Led employee engagement, communications, mentoring, and cross-functional improvement workgroups.
Additional Skills
- Advanced proficiency in Microsoft Office Suite, including Outlook, Word, Excel, PowerPoint and Microsoft Teams
- Excellent oral and written communication skills
- Strong interpersonal, organizational, and analytical skills
- Function in a team environment and share responsibilities, roles, and accountability with peers and other team members
- Sound decision-making, problem-solving, and prioritization skills
- Team player and promote positive team environment
- Ability to manage multiple projects and priorities
Timeline
Manager of Operations: MA Customer Service
BlueCross BlueShield of Tennessee
05.2024 - Current
Operations Supervisor: Medicare Advantage Customer Service
BlueCross BlueShield of Tennessee
07.2018 - 05.2024
Supervisor Clinical Support: Medicare Advantage Utilization Management
BlueCross BlueShield of Tennessee
12.2016 - 07.2018
Technical Team Expert: Medicare Advantage Customer Service
BlueCross BlueShield of Tennessee
04.2015 - 12.2016
Customer Service Representative: Medicare Advantage Customer Service
BlueCross BlueShield of Tennessee
02.2013 - 04.2015
Nanny
Drs. Clifton and Erin Reade
01.2009 - 02.2013
Associate of Applied Science -
Chattanooga State Technical Community College
LPN Program -
Chattanooga State Technical Community College
Certified Healthcare Customer Service Associate
Lean Six Sigma Green Belt
Lean Six Sigma Yellow Belt