MICHELLE LUMBLO

Managed employer group and member accounts, handling benefits, eligibility, claims, and enrollment inquiries. Resolved complex customer and provider issues related to claims, billing, and coverage. Coordinated with internal teams to ensure accurate plan administration and timely issue resolution. Maintained account records and ensured compliance with company policies and healthcare regulations. Built strong client relationships through exceptional customer service and account support.

Analyzed and maintained health plan documents to ensure accuracy, compliance, and alignment with client requirements. Drafted and updated plan language, amendments, and benefit summary changes for employer-sponsored health plans. Collaborated with legal, compliance, and operations teams to support accurate plan administration. Reviewed documents for consistency with contracts, policies, and regulatory guidelines. Researched healthcare regulations and implemented required document updates. Led staff training initiative for document analysis functions, serving as a subject matter expert on policies, procedures, and quality assurance standards.

Delivered high-quality customer service by addressing inquiries and processing account resolutions. Collaborated with cross-functional teams to verify information and resolve issues. Trained new team members on customer service protocols and software tools. Assisted customers in understanding benefits and coverage options clearly. Handled difficult situations with tact, diplomacy, and professionalism. Resolved complex customer issues and escalations with accuracy, professionalism, and attention to detail.