Michelle Fuller

I left Anthem for health reasons. During this time of unemployment, I have assisted my brother with childcare, as well as helped my elderly parents through some of their health problems. I also completed a medical coding and billing course through Medcerts, and received state certification in September 2024.

Facilitated members with various requests, ranging from finding providers to updating information. • Quoted and sent benefits and eligibility information to members and providers. • Assisted with claims, including the review of claims forms to assess why they were denied or how they were paid. • Assisted with reading and sending EOBs. • Also sent claims for adjustments if needed.

Outsourced to a third party to take dental benefit calls. • Assisted callers with benefits, claims status, and how to send claim appeals, as well as grievances. • Assisted providers with benefits, to include fax or email of benefits breakdowns and fee schedules. • Reviewed ADA codes to assist in claims filing, or correction on rejected claims.

I worked for several call centers as a temporary employee. Companies include Walgreens, Frontline Call Center, Paramount Staffing LLC, Concentrix, and Willis Towers Watson.

Duties varied, but included facilitating members with billing and payments. Assisted with updating demographic information. Also assisted with grievance calls and assisted with Medicare enrollment.

Assisted a high volume of callers via phone while maintaining company quality and service standards. • Assisted members and providers with claims, including submission, rejection, adjustments, appeals, and payment status. Provided a fee schedule, remittance advice to providers, and EOB to members via fax, mail, and phone. • Upheld all privacy and security requirements per HIPAA. • Participated in team meetings, cross-training, and training new employees to keep updated on new policies, procedures, and company operations.

Temporary to permanent position with Aflac. Maintained quality levels above prescribed minimums to support team productivity and efficiency. Communicated with coworkers regarding deadlines and project milestones. Input client information into the company database to provide leaders with quick access to new member applications. Identified errors in data entry and related issues by mentioning them to team members for correction. I was a top-five producer.

Cultivated strong, value-added relationships with customers by delivering product knowledge to drive business development. Tracked each interaction for auditing, reporting, and training purposes. Reviewed customer data to assess current issues and determine potential solutions. Escalated customer concerns, store issues, and inventory requirements to supervisors. Addressed customer service inquiries quickly and accurately.

Provided members with benefits and claims information. Sent claims back for reprocessing at member or provider request.

Updated demographic information.