Michele D. Wilson
Jacksonville,FL
Summary
Dynamic professional with extensive experience at Florida Blue, excelling in data analysis and client support. Proven ability to enhance operational efficiency and ensure compliance standards. Adept at multitasking and fostering teamwork, I effectively resolve issues while maintaining attention to detail, driving positive outcomes in high-pressure environments. Personable and dedicated customer service representative with extensive experience in 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
44
44
years of professional experience
1
1
Certification
Work History
Seasonal Customer Service Advocate
Duval County Supervisor of Elections
07.2018 - 11.2024
- Front Desk Receptionist at the Elections Center welcoming visitors, local media staff and precinct workers
- Answered incoming telephones calls from registered voters regarding their voter record status
- Contacted precinct workers to remind and confirm attendance of approaching training class
- Completed paperwork where voters requested updates to their current voter record
- Supported with the Primary and General Election Day processes and procedures for each precinct locations
- Aided with the day to day internal process of the election processes
Independent Insurance Agent
Florida Care Assurance Group, LLC
09.2017 - 07.2018
- Licensed Health Insurance Agent by the State of Florida
- Center for Medicare Services Certified
- Local Agent in partnership with Florida Blue Insurance
- Marketing and selling Medicare Advantage, Health, Dental and Ancillary Products
- Educate and provide awareness to prospective and enrolled clients on the state and importance of healthcare
- Liaison and advocate on the behalf of my enrolled clients and the Healthcare Marketplace or the Health Insurance Company
Administrative Assistant (part-time)
Florida Wilbert
04.2016 - 11.2016
- Company Overview: Casket, Vaults and Burial Service Provider
- Prepared weekly and monthly routing reports for rollup to corporate
- Received incoming telephone calls
- Prepared work-request tickets for Funeral Director delivery orders
- Assisted walk-in customers with pick-up orders and current on-hand inventory items
- Followed-up with Funeral Directors for clarification on burial services tickets
- Contacted Cemetery Sexton to verify actual location of grave
- Recorded customer information from local newspaper obituaries
- Recorded and filed vendor bills
- Completed general office work and responsibilities
- Casket, Vaults and Burial Service Provider
Sales Analyst II - Sales Administration
Florida Blue
06.2010 - 12.2014
- Analyzing, interpreting and maintaining data structure and files of standard and Non-Standard files that enable group rating, enrollment and maintenance
- The data files encompass many systems including but not limited to Siebel, eRate, Regular Business Membership System (RBMS), My BlueInsight (MBI)
- Ensure data integrity and coding structures are in compliance with Corporate and Operational policies and procedures
- Process new and renewal group sales and maintenance files for updating benefits and rates for various downstream business partners
- Research problems and make decisions based upon analysis, knowledge, experience, guidelines input and judgment
- Analyze, summarize and reconcile sales data for Non-Standard strategic accounts
- Work with business partners from all areas of the company to ensure group data is accurate and enrollment is complete in accordance to divisional timelines and goals
- Utilize Underwriting guidelines to ensure that they are compliant with group files and regulations established by the Florida Office of Insurance Regulation (OIR)
- Process group request for Sales Representatives as it releases to New Sales, Maintenance and Renewals for group business
Lead Sales Administrator - Sales Administration
Florida Blue
08.2009 - 06.2010
- Liaison for Sales Administration Support Team with Sales & Service Staff, Implementation Team, Product Rate Administration (PRA), Group Underwriting and Enrollment-Membership & Billing (EMB)
- Travel to field offices monthly to assistance the Sales and Services staff supported by my Sales Coordinator team
- Support the processing of Standard and Non-Standard quotes, new business, renewals and maintenance groups
- Utilize Siebel tool to process and monitor the group movement to ensure timely processes goals achieved
- Conduct bi-weekly meetings with Sales Coordinators to review Sales Bulletins, process changes, training needs, software application tool updates/implementation and coordinate with statewide offices for consistency
- Proactively and effectively monitor team productivity and quality to improve overall team performance
- Provide coaching to team members on behaviors, reworks, process defects and quality results
- Provide ongoing individual and team training for continuous improvement
- Prepare management reports for MBO sessions
- Support with TNL processing
- Participate in Sales Coordinator training sessions
- Facilitate the weekly Sales Lead Administrators workgroup statewide sessions
- Demonstrated SME for My BlueInsight (MBI) tool
- Utilize MBI to retrieve and train Sales Representative on reports
- Support Sales staff at group Benefit Fairs
Project Analyst - Sales Business Management
Florida Blue
02.2006 - 08.2009
- Complete Provider Disruption reports for prospective and existing business with a goal of accomplishing a 90% or higher disruption match rate
- Bench Strength for the Rapid Process Improvement Project for completing Provider Disruption Analysis effectively and efficiently
- Provide support to Information Management Service Center Queue for ad-hoc report requests by triaging all requests forwarded to the centralized ad-hoc queue
- Account Specific Reporting project team member for My BlueInsight (MBI) web-based reporting tool requirements and development of the reporting mechanism for the implementation
- Champion of the implementation of the Group Underwriting DataMart (GUDM) Automation Reporting Project, monitor and update the statewide report matrixes and provide assistance of report requirements
- Maintain the Major Accounts Consulting Team mailbox to ensure that internal and external partner’s inquiries are completed in a timely and accurately
- Retrieve and distribute group specific reports from GUDM, Oracle, Major Accounts Reporting System (MARS), MBI, Enterprise Data Warehouse and Strenuus Network 360 Comparison tools
- Possess positive working relationships with Sales, Consultants, Agents and Informational Management
Operations Analyst III - Group Sales
Florida Blue
11.1998 - 01.2006
- Provided leadership and ensured implementation of the Reporting Initiative Project for Major Accounts Groups Statewide
- Retrieved and distributed claims experience reports from GUDM, MARS and Oracle applications monthly/quarterly for Jacksonville, Gainesville and Pensacola Major Account group business
- Trained Statewide Sales Staff on multiple reporting tools
- Analyzed claims experience reports data and communicated critical findings to Sales and Renewal Representatives
- Subject Matter Expert for critical Sales claims and customer service inquiries for all product lines
- Ambassador for Sales on the HIPAA-AS requirements of the federal mandate
- Alternate participant on the Legislative Implementation Group (LIG Workgroup)
- Maintained positive relationships with Sales Staff, Consultant, Agents, Customer Service Personnel, Other Payable Liability, Proposal Administration, Major Account Consulting Team, and Decision Support Operations
- Assisted with group enrollment meetings, benefit seminars and health fairs
- Handled the processing of member wellness data into the on-site computer system
- Generated group wellness results reports for presentation to the Benefit Administrators and Decision Makers
- Data Owner for Northern Sales team for Folder Access Self-Service Tool (FASST)
Quality Analyst - Northern Operations
Florida Blue
06.1997 - 11.1998
- Achieved an in-depth understanding of Claims, Customer Service, Suspense and Adjustment processing
- Conducted internal auditing and monitoring of claims and inquiries for entry, suspense, and customer service for Local and Individual Business divisions
- Complied monthly and quarterly reports on individuals and departmental quality scores
- Coached and provided remedial training to Service Associates experiencing quality problems
- Identified and communicated problems relevant to benefit and guideline uncertainties for claims processing systems to Operational Analysts and training department
- Maintained open lines of communication with impacted areas Managers and Senior Advisors
Senior Claims Advisor
Private Business
05.1990 - 06.1997
- Provided team training on claims processing and operational systems for all lines of business
- Supported Marketing Representatives and team members on claims and inquiries
- Maintained effective communications verbally and written consistently with external and internal customers
- Team member of the claims and customer service process improvement implementation workgroup
- Provided customer callbacks to members in absence of Supervisor to ensure problems were identified and resolved timely
- Group Champion for group contracts: Duval County School Board; Kinco Windows and Beaver Street Fisheries
- Furnished feedback and training to team members exhibiting quality and additional training needs on procedural guidelines
- Facilitated daily management of aged inventory and assisted in finalization of claims and inquiries
- Fire and Safety Captain
Claims Examiner
Private Business
10.1980 - 05.1990
- Entered live claims into the claims processing system
- Worked suspended claims to ensure effective processing
- Completed Adjustments on claims impacted by system problems or incorrect benefits quoted
- Attended training sessions on claims guideline and procedural changes
- Maintained working relations with Customer Service Representatives, Senior Advisors, and Auditors
- Provided training to new team members on claims processing for entry and suspense
- Prescreened entry claims for trainees to assist with identifying required entry fields
Education
Bachelor of Science - Business and Professional Management
Nova Southeastern University
Fort Lauderdale, FL03.2000
Associate of Science - Secretarial Management
Florida Community College
Jacksonville, FL04.1980
High School Diploma - Honor Graduate
Stanton Senior High School
Jacksonville, FL06.1977
Skills
- Customer service
- Data entry
- Health insurance
- Voter Record Administration
- Electoral Procedures
- Client Support Expertise
- Telephone communication
- Issue Resolution
- Attention to detail
- File Organization
- Team collaboration
- Training Event Organization
- Report generation
- Compliance standards
- Conflict resolution
- Detail-Oriented Note Taking
- System implementation
- Teamwork skills
- Estimating
- Technical support
- Multitasking and prioritization
- Proofreading
- Multitasking and organization
- Strong teamwork
- Calm under pressure
Certification
2-15 State of Florida in Life including Variable Annuity & Health
Mobile Telephone
(904) 708-2275
References
- Deena Townsend, Manager at Florida Blue, (904) 572-8233
- Katrell McKenzie, Call Center Manager, Duval Elections, (904) 610-4446
- Alisa Harrell, Facilitator of Friend of the Bradham-Brooks Northwest Branch Jacksonville Public Library, (904) 553-3738
Volunteer Experience
- Strong Advocate for Breast Cancer AwarenessSurvivor
- Active Teacher of Vacation Bible School (Church Organization)
- Friends of the Bradham-Brooks Northwest Branch Jacksonville Public Library
- Former Member of Florida Blue Corporate School Backpack Project
- Past Member of Stanton High School Alumni Committee
- Project Moses-Hold Out the Lifeline (Former Member - Church Organization)
- Member of the Greater Mt Vernon Missionary Baptist Church
- Former Band Booster Member for Edward Water College
Computer Applications
- Voter Focus System
- Affordable Healthcare Enrollment System
- Big Wave – Government Website for Prospect looking for Sales Agents
- Windows Operating Systems
- Microsoft Office Suite
- World Wide Web (Internet / Intranet)
- Social Media (Facebook, Instagram and Twitter)
- Siebel Applications
- ERate- Florida Blue Application
- Field Group Management System
- Provider Information Platform
- Regular Business Management System (RBMS)
- Manage Health Systems (MHS)
Workgroups
- Corporate Training
- Healthcare and Healing Outreach Education
- Visual Management Workgroup for Sales Operations – Black Belt Project
- Sales Diversity Business Council
- My BlueInsight (MBI) Development
- Blue Belt RPI for Provider Disruption Analysis processes
- SME for Sales Department on HIPAA-AS Project teams
- Operational Readiness Management Migration
- Legislative Implementation Workgroup
- Online Provider Directory Redesign
- Field Group Management (FGMS)
- Six Sigma-New Sales Contract for Group Business 51-299
- Six Sigma Yellow Belt
- My BlueInsight (MBI) Web-based Reporting Tool
- Diversity (Individual and Team) Sessions
- E-Learning Courses
- Ingenix Disruption Analysis
- Strenuus Network Comparison Online Tool
- Enterprise Data Warehouse (EDW): Siebel Analytics Reporting Systems (Fred, Sales Dashboard, Prime Pharmacy Reporting, Provider Match)
- Project Management Methodology
- Managing at Blue Cross Blue Shield of Florida
Affiliations
- Strong Advocate for Breast Cancer Awareness Pink Bag Distributor
• Friends of the Bradham-Brooks Northwest Branch Jacksonville Public Library
References
References available upon request.
Timeline
Seasonal Customer Service Advocate
Duval County Supervisor of Elections
07.2018 - 11.2024
Independent Insurance Agent
Florida Care Assurance Group, LLC
09.2017 - 07.2018
Administrative Assistant (part-time)
Florida Wilbert
04.2016 - 11.2016
Sales Analyst II - Sales Administration
Florida Blue
06.2010 - 12.2014
Lead Sales Administrator - Sales Administration
Florida Blue
08.2009 - 06.2010
Project Analyst - Sales Business Management
Florida Blue
02.2006 - 08.2009
Operations Analyst III - Group Sales
Florida Blue
11.1998 - 01.2006
Quality Analyst - Northern Operations
Florida Blue
06.1997 - 11.1998
Senior Claims Advisor
Private Business
05.1990 - 06.1997
Claims Examiner
Private Business
10.1980 - 05.1990
Bachelor of Science - Business and Professional Management
Nova Southeastern University
Associate of Science - Secretarial Management
Florida Community College
High School Diploma - Honor Graduate
Stanton Senior High School
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