Michele Winslow
Trevor,WI
Summary
Over 25 years of customer service and management experience with a proficiency with web-based CRM tracking systems seeking an opportunity to grow with my current skill set and become an asset to a growing company. I have extensive experience in high volume workflow and high volume inbound/outbound call abilities. Personable and dedicated Customer Service Representative with extensive experience in the health insurance industry. 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. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses.
Overview
14
14
years of professional experience
Work History
Loss Draft Specialist
Assurant
Duluth, MN
08.2023 - Current
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Responded promptly to customer inquiries via email or telephone calls.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Collaborated with fellow team members to manage large volume of claims.
- Ensured that all necessary paperwork was properly filed in accordance with company policy.
- Assisted new policyholders with processing claims.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Reviewed and processed loss draft documents to ensure accuracy of information.
- Maintained accurate tracking systems to monitor progress of each case.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Identified needs of customers promptly and efficiently.
- Answered 50+ calls per shift to assist with customer questions and concerns.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Assisted with customer requests and answered questions to improve satisfaction.
- Recognized by management for providing exceptional customer service.
Prior Authorization Representative
LaSalle Networks/Option Care Health
Remote(Work from home)
02.2023 - 07.2023
- Registering patients for infusion services by entering demographic and collecting insurance
- Initiating prior authorizations for infusion medications
- Checking status on prior authorizations, allowing no more than 48 hours to go in between
- Processing prior authorization denials
- Assisting with starting the appeal process for prior authorization denial.
- Maintained updated knowledge through continuing education and advanced training.
- Made outbound calls to insurance companies, patients and physicians to perform eligibility checks for patients.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Verified patient's insurance eligibility prior to appointment date for payment purposes.
- Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
- Reviewed prior authorization requests for completeness and accuracy.
- Processed appeals for denials in accordance with established procedures.
Specialty Benefit Verification and Processing
CVS/Caremark Specialty Pharmacy
Buffalo Grove, IL
10.2017 - 07.2022
- Processed and scheduled insurance claims for CVS Specialty Pharmacy
- Main requirements were to process and schedule insurance claims for Specialty Pharmacy, which only dispense infusion/injection medications, such as chemotherapy, Multiple Sclerosis infusions, HIV infusions, etc
- Verify every claim is followed up in maximum of 48 hours
- Initiating all prior authorizations that are needed and acting as liaison between MD office and insurance company
- Check incoming team mailbox for escalations and following up and resolving immediately
- Taking incoming calls from doctors, nurses, and patients to resolve escalating issues regarding claims
- Verify all of patient's information every time spoken to, HIPAA compliant
- Resolving issues with patients not being able to afford medication
- Running reports and working on various special projects for management
- General customer service and data entry when volume is low
- Trained on Salesforce.
- Recognized by management for providing exceptional customer service.
- Maintained open communication with team members and stakeholders, resulting in successful project outcomes.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Exceeded customer satisfaction by finding creative solutions to problems.
- Leveraged MS Office Suite skills to input and compile data gathered from various sources.
- Planned and completed group projects, working smoothly with others.
- Maintained updated knowledge through continuing education and advanced training.
Customer Service Management/File Clerk
Great Lakes Gelatin Company
Grayslake, IL
05.2015 - 02.2017
- Received inbound and outbound calls including processing orders and credit card information
- Educated customer credentials and business accounts while maintaining the database
- Obtain business licenses and reseller agreements
- Worked directly with the director of operations, accounting and management
- Performed data entry, scanning in all required paperwork and updated existing excel spreadsheets
- Entering orders, resolving complaints and setting up RMA's
- Received projects directly from the owner, running reports and making all changes necessary.
- Scanned documents into electronic database system for archiving purposes.
- Resolved discrepancies between physical files and digital databases.
- Coded index materials with stamp identification for filing.
- Performed data entry tasks related to filing activities.
- Handled confidential material with discretion in accordance with company regulations.
- Assisted with purging inactive files following retention schedules set forth by department policies.
- Added new material to file records or created new records.
- Audited existing files to ensure accuracy of information on a regular basis.
Customer Retention Specialist, Level 2
Time Warner Cable
Milwaukee, WI
10.2013 - 03.2015
- Updated customer accounts and resolved customer complaints, by providing discounts and promotions for customers
- Maintaining customer accounts as well as retain customers for Time Warner Cable
- Updating accounts and resolve customer complaints and issues
- Placing work orders and trouble calls.
- Verified order changes to resolve customer complaints or concerns.
- Explained new products and services to customers.
- Analyzed customer feedback to identify areas of improvement in customer retention programs.
- Prepared and evaluated CRM reports to identify problems and areas for improvement.
- Responded promptly to emails from existing customers seeking assistance or advice.
- Took special orders in person and over telephone, generating additional revenue every month.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Exceeded established service goals while leveraging customer service, sales and employee management best practices.
- Liaised between customers and retail buyers to expedite orders and meet customer demands.
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
Customer Service Management
OpticSale.com
Prospect Heights, IL
04.2010 - 08.2013
- Entered orders, listed items for sale, researched items for sale, priced items for sale, customer escalations directly
- Supervising and managing the customer service staff
- Received and resolving escalated management calls, order supplies, report directly to the owner of the company
- Filing of USPS and UPS claims is also a responsibility of customer service supervisor
- Training and supervising staff, designed policies and templates for customer service.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Achieved cost-savings by developing functional solutions to problems.
- Identified needs of customers promptly and efficiently.
- Collaborated with cross-functional team to define features and build powerful and easy-to-use products and customer-facing workflow tools.
- Assisted with customer requests and answered questions to improve satisfaction.
- Completed day-to-day duties accurately and efficiently.
Education
High School Diploma -
Westosha Central High School
Salem, WI06-1998
Skills
- Highly Proficient in MS Office
- Experienced with high volume product work flow
- Communications and Conflict Resolution Skills
- Excel in both incoming and outgoing call environments
- Data entry-75wpm
- Training and supervising staff
- Designed policies and templates for customer service manuals
- Processing shipping damage claims
- HIPAA compliancy trained
- Healthcare insurance processing
- Multitasking
- Experienced with insurance processing systems
- Experienced in CRM based tracking systems
- Claims Management
- Insurance Knowledge
- Insurance Claim Forms Review
- Customer Service
- Active Listening
- Decision-Making
- Account Management
- Background in Insurance
Timeline
Loss Draft Specialist
Assurant
08.2023 - Current
Prior Authorization Representative
LaSalle Networks/Option Care Health
02.2023 - 07.2023
Specialty Benefit Verification and Processing
CVS/Caremark Specialty Pharmacy
10.2017 - 07.2022
Customer Service Management/File Clerk
Great Lakes Gelatin Company
05.2015 - 02.2017
Customer Retention Specialist, Level 2
Time Warner Cable
10.2013 - 03.2015
Customer Service Management
OpticSale.com
04.2010 - 08.2013
High School Diploma -
Westosha Central High School