Michelle Heferle
Blasdell,NY
Summary
Accomplished Broker adept at growing business through deep knowledge of Health Insurance Industry and strong relationship-building abilities. Leveraging numerous years of experience to generate profits and dividends.
Overview
17
17
years of professional experience
1
1
Certificate
Work History
INDEPENDENT BROKER, Medicare Sales Representative
Current
- Educate members on original Medicare, Medicaid, Low Income Subsidy, Epic, and the Medicare Savings Program.
- Assist members in obtaining extra benefits.
- Conduct an in-depth analysis to identify current and potential member needs
- Pull in specific data such as prescriptions, physicians, and other pertinent information so benefit comparisons can be made.
- Educate members on plan differences, rates, networks, star ratings, benefits, and enrollment periods.
- Enroll members in Medicare Advantage, Medigap, PDP, and Ancillary Benefits
- Continue to build and maintain community relationships.
- Retain current book of business by problem solving, and resolving issues the member may experience once enrolled.
- Re-review options when needed.
- Review group coverages, premiums, and benefits.
- Determine with member if it is advantageous to move out of group coverage and move into another more cost-effective option.
AAA, Medicare Sales Representative
AAA Of Western NY
, NY
09.2021 - 07.2023
- Assisted members with navigating through enrolling in original Medicare, and Medicare options.
- Selected the best Medicare Options for each client such as Medigap, PDP, or Medicare Advantage.
- Utilized tools such as Medichoice destination RX to find the best products available in the marketplace.
- Obtained license to sell Aetna, Humana, Highmark, Univera, Excellus, CDPHP, Independent Health, United Health Care, and MVP.
- Instrumental in retaining a large portion of AAA's book of Medicare business, while continually striving to grow our Medicare population.
- Completed Health Risk Assessments.
- Helped potential eligible members with obtaining and completing Medicare Savings Applications, as well as Low Income Subsidy applications.
- Developed community relationships especially with Veteran's and the underserved.
FIDELIS CARE, Medicare Sales Representative
Fidelis Care
, NY
01.2018 - 06.2021
- Enrolled members in Medicare Advantage and Dual Advantage Plans at sites, home visits, or at the Fidelis Community Benefits Office.
- Responsible for developing new sites by establishing and maintaining strong business relationships.
- Generated new leads for Medicaid Representatives.
- Represented Fidelis at various sites, and events throughout my assigned territory.
- Provided outstanding customer service to our existing, and potential clients, by making ethical choices for our extremely vulnerable seniors, and disabled population.
BLUECROSS BLUESHIELD OF WNY, Senior Provider Relations Specialist
Blue Cross And Blue Shield Of WNY
, NY
01.2012 - 01.2017
- Managed one of the largest and most demanding territories.
- Included but not limited to: City of Buffalo, Blasdell, Hamburg, and Lackawanna; several Community Centers, as well as University at Buffalo providers.
- Responsible for repairing strained relationships with provider groups.
- Built and maintained strong business relationships with all providers.
- Completed on-site visits, Medicare Advantage Orientations, and other visits as needed.
- Credentialed new providers, as well as add lines of business for existing providers.
- Represented Provider Relations on teams and committees as delegated by management.
- Interacted with various departments throughout the organization to resolve escalated claims and billing issues.
- Worked with various departments to resolve Department of Health audits
- Represented Provider Relations at the chiropractic seminars, the PCMH dinner, OPA provider meet and greet, and Medicaid incentive seminars
- Responsible for unique negotiating and contracting with providers
- Conducted large scale PCMH, Pay for Performance, and Align overviews at several Large Provider Groups
- Assisted providers through educational processes in meeting their Pay for Performance goals which directly helps the company meet our Hedis goals.
BLUECROSS BLUESHIELD, Senior Customer Service Representative
01.2007 - 01.2012
- Worked with Large Group Sales Department on securing 5,000 new members annually.
- Assisted existing Account Executives with retaining and servicing BSBS of WNY most technical accounts.
- Conducted Open Enrollment meetings and serviced all new large group business accounts.
- Provided expert analysis on all questions and comparisons regarding HMO's, PPO's, EPO's, Indemnity Products, and CDHP's.
- Contributed to Large Group Department in securing a 20m account.
- Supported, and mentored new and existing customer service representatives in fast paced call center.
- Provided customer service through Pro-Serve, Pharmacy Vendor to various Blue Cross Plans throughout the Country, and their members.
- Sold and enrolled new members in Child Health Plus, Medigap, and direct pay policies, through telephone, and face to face walk-in interaction.
- Assisted all members, providers, brokers, and groups.
Education
Supervisory Studies
Cornell University
Buffalo State CollegeTimeline
INDEPENDENT BROKER, Medicare Sales Representative
Current
AAA, Medicare Sales Representative
AAA Of Western NY
09.2021 - 07.2023
FIDELIS CARE, Medicare Sales Representative
Fidelis Care
01.2018 - 06.2021
BLUECROSS BLUESHIELD OF WNY, Senior Provider Relations Specialist
Blue Cross And Blue Shield Of WNY
01.2012 - 01.2017
BLUECROSS BLUESHIELD, Senior Customer Service Representative
01.2007 - 01.2012
Supervisory Studies
Cornell University
Skills
- Cost Calculations
- Clientele Development
- Market Trends Analysis
- Regulatory Compliance
- Prospecting and Networking
- Community Engagement
- Lead Conversion
- Eligibility Determination
- Enrollment Processing
Certification
- Accident, Health, and Life License - 2017-Present
- Ahip Certification 2017-Present
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