Michelle Eva Albert
Green Bay,WI
Summary
Diligent telecommuter with solid background in managing client relationships and ensuring customer satisfaction. Proven track record of driving revenue growth through strategic account management and cross-functional collaboration. Demonstrated ability to analyze client needs and deliver tailored solutions, enhancing both client retention and business outcomes. Results-driven professional with comprehensive experience in account management, focusing on building strong client relationships and driving business growth. Adept at negotiating contracts, resolving client issues, and aligning services with client needs. Proven success in fostering team collaboration and adapting to dynamic environments, showcasing excellent communication and problem-solving skills. Skilled account management professional with proven track record in fostering client relationships, driving revenue growth, and managing complex accounts. Known for strong focus on team collaboration, adaptability, and delivering results. Expertise includes strategic planning, client communication, and problem-solving. Highly reliable and flexible in meeting changing business needs.
Overview
14
14
years of professional experience
Work History
Apple Service Escalation Account Manager
United Healthcare
02.2023 - Current
- Team Lead roll
- Team SME
- Monitor schedules for adherence and request minor schedule updates
- Successfully resolved escalated issues, preventing potential loss of valuable clients while maintaining positive relationships with all parties involved.
- Conducted regular account reviews to identify areas for improvement and ensure continued success.
- Host and create up training and refresher courses for the team
- Answer questions from dedicated Apple Nurses, Agents, SAM’s, and eligibility checks in real time
- Take on escalations and complex cases from Apple and provide resolution not previously attained
- Reconsider claims for simple and complex claim adjustments
- Create benefit exceptions for escalations and misquotes
- Coaching with agents to teach them skills so they can move up within the company
- Coaching with agents to ensure quality and complete concierge care is being provided on each call
- Back up agents and take holding calls from cue
- Create GAP exceptions at members request for OON providers and care
- Work directly with Pharmacy and Medical Directors on complex cases to provide end to end resolution
- OJT for Tier 2 claims uptraining of Apple advocates (April-July 2023)
- I have over 120 SNI/Escalated members and 7 VIP members, providing them and their families the highest level of service
Apple Advocate
United Healthcare
01.2022 - 01.2023
- Took inbound calls from members about benefits, claims, eligibility
- Answered routine behavioral health benefit questions, status UBH providers in Linx, identified UBH claim issues and worked with UBH team to provide resolution
- Identify complex claim issues and reprocess claims real time
- Became members main point of contact, providing complete end to end resolution on all issues for complex medical cases and SAM escalations
- Participated in professional development initiatives for consistent improvement and up-to-date knowledge of emerging trends and best practices.
- Delivered friendly service and offered expert support in every interaction.
- Managed complex caseloads with diligence, prioritizing tasks to ensure timely resolution of cases.
- Conducted comprehensive client interviews, gathering relevant information to build a strong case foundation.
- Worked effectively with fellow team members to coordinate effective solutions to any question or concern.
- Assisted with applications and collected required paperwork to help individuals register for supportive services.
- Assisted individuals in navigating processes and procedures to resolve issues, understand rights and express views.
- Established trusting relationships with clients by maintaining open lines of communication throughout the entire representation process.
- Responded to emails from members in PHMC secure messaging.
- Took inbound chats in Genesys and Live Person
- Worked on VIP and SAM escalations with leadership
- Consistently met and exceeded Quality and PG expectations
- Frequently collaborated with other departments to provide resolution on complex issues to ensure complete resolution of issues
- (I.E. Pharmacy Director, Medical Director … etc.)
- Pharmacy issue resolution and used various work platforms including Navigator and PAS for pharmacy
Senior Health Advocate4Me Rep T2
United Healthcare
01.2019 - 01.2022
- Simplify health care system guidance and drive engagement in programs across the continuum of care
- Conduct provider searches
- Perform closed, denied, and simple claim adjustments
- Meet Quality and Customer Satisfaction requirements
- Maintain accurate documentation in ORS
- Take accountability and ownership for any follow – up work needed to resolving and close issues
- Take ownership of resolution of inquiries end to end
- Resolve issues including benefits, eligibility and claims as needed
- Pitch clinical programs as appropriate
- Identify anticipate and resolve Member issues to prevent future calls
- Maintain proficiency in all technical applications (technical skills and system knowledge)
- Comply with all current policies, procedures, and workflows
- Ability to works independently and collaborate with others
- Serve as a resource for others
Advocate4Me Rep T1
United Healthcare
01.2016 - 01.2019
- Providing expertise and customer service support to members as a part of United Healthcare Advocate4Me model
- Direct phone-based customer interaction to address complex member needs and provide recommendations on services that may help close gaps in care for the member and/or the member’s family
- Demonstrate a great depth of knowledge/skills in own function
- Proactively identifies solutions to non-standard requests
- Work with team to solve complex problems and solve moderately complex problems on own
- Plans, prioritizes, organizes and completes work to meet established objectives
- Exceeded performance targets through diligent work ethic and focus on results-driven tasks.
- Enhanced company reputation by providing exceptional customer service and support.
Check Out Supervisor
Sam’s Club
01.2011 - 01.2016
- Managing cash register associates, assigning tasks, checking associate compliance of assigned task, and ensuring efficient flow of business
- Communicating, and updating other managers about daily business
- Assisting in hiring, scheduling, promoting, and coaching of associates
- Selling different club memberships
- Maintaining the Sales Floor in accordance with company policies
- Providing excellent service, and helping customers find solutions to their needs
- Volunteered for extra shifts during holidays and other busy periods to alleviate staffing shortages.
- Assisted in implementing loss prevention measures by monitoring high-risk areas and reporting suspicious activities to management.
Education
Cosmetology -
Frederick School of Cosmetology
Frederick, MD01.2016
Global Business -
UMUC
College Park, MD01.2014
Skills
- Windows 10
- Power Point
- Word
- Excel
- Outlook
- Medical Mastermind
- OSX
- Business Management
- Marketing
- Information Technology
Accomplishments
- Developed and marketed a mentoring program for students with the local high school for elementary school students.
- Got promoted in Sam’s Club within one year of being employed.
Timeline
Apple Service Escalation Account Manager
United Healthcare
02.2023 - Current
Apple Advocate
United Healthcare
01.2022 - 01.2023
Senior Health Advocate4Me Rep T2
United Healthcare
01.2019 - 01.2022
Advocate4Me Rep T1
United Healthcare
01.2016 - 01.2019
Check Out Supervisor
Sam’s Club
01.2011 - 01.2016
Global Business -
UMUC
Cosmetology -
Frederick School of Cosmetology
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