Michelle Osborne
Brockton,MA
Summary
Reliable Manager demonstrating high level of ownership and initiative. Possessing exceptional work ethic and desire to go above and beyond to exceed company expectations. Offering knack for building productive working relationships. Successful in fast-paced, deadline-driven environments to manage goals and team development. History of thriving in team-oriented environments.
Overview
16
16
years of professional experience
Work History
Coordination of Benefits MANAGER
Blue Cross Blue Shield of Massachusetts
Quincy
11.2022 - 07.2023
- Define team or unit goals, schedules, assigns, and monitor work quality/quantity and completion
- Aids in the Performance Plan process through goal setting, checking of achievement
- Prepare and deliver oral presentations
- Train and schedule training sessions with all new associates
- Coach associates in problem resolution and work completion
- Collaborates with other areas to recommend new work methods and increase efficiencies (workgroup's)
- Daily/Weekly /Monthly reporting and trending analysis on several lines of business
- Reviewed insurance contracts including medical, dental, vision, life, disability, and voluntary products to ensure compliance with applicable laws
- Assisted in developing communication materials for distribution to employees regarding benefit changes or additions.
Coordination of Benefits Supervisor II
Blue Cross Blue Shield of Massachusetts
Hingham
01.2017 - 11.2022
- Led team of 10 to 19 full time employees
- Handling complex cases, issues, and escalated calls to resolution
- Promotes cooperation in functional and cross-functional teams
- Liaison between COB venders and partners
- Reviewed claims data regularly to find areas where cost savings were realized through improved utilization of available resources
- Monitored compliance with federal and state regulations related to benefits.
COB Medicare Specialist II
Recovery & Provider Audit Blue Cross Blue Shield of Massachusetts
Hingham
01.2015 - 01.2017
- Point of contact for coverage for supervisor calls and questions
- Council for Affordable Quality Healthcare (CAQH) information review for other insurance information
- Section 111 Medicare Secondary Payer (MSP) review and updates
- Medicare and Other insurance claims adjustment and review
- Upload monthly and weekly reports from Tumbleweed for review.
Reporting ANALYST
Claims Operations Blue Cross Blue Shield of Massachusetts
Hingham
01.2014 - 01.2017
- Supplied reporting support to the Claims Operation division by utilizing Data Warehouse, Web focus, CA View, Transaction Index Measures (TIM)
- Supplied technical support for existing reports, dashboards, and other tools
- Maintain and identify TR Log pending reports variables to manage claims first pass rate
- Participated in Non-Standard Operations (NSO) workgroups
- Liaison between Claims and Coordination of Benefits for error reporting, corrective action, and tracking.
Coordination of Benefits SPECIALIST
Provider Audit Blue Cross Blue Shield of Massachusetts
Hingham
01.2008 - 01.2014
- Lead for the Correspondences Team; responsible for all incoming inventories
- Primary resource for escalated items from Provider, Member, and internal Departments
- Manage report and the delegation of work
- Processed claims and adjustments
- Investigated and resolved claims for Finance audits
- Improved workflows and procedures within the department
- Implemented scripts to alleviate negative work in the area
- Trained new associates within Blues cross and our outsourced vender's.
Education
High School Diploma -
Jeremiah E Burke High School
Dorchester, MA05-1986
Skills
- Microsoft Office Suite
- Confidential Records Management
- Complex Problem-Solving
- Critical Thinking
- Schedule Preparation
- Meetings And Presentations
- Team Collaboration
- Staff Development
- Performance Evaluations
- Customer Service
- Documentation And Reporting
- Cross-Functional Team Management
- Project Management
- Expectation Setting
- Time Management
- Information Confidentiality
- Resources Allocation
- Staff Management
References
References available upon request.
Timeline
Coordination of Benefits MANAGER
Blue Cross Blue Shield of Massachusetts
11.2022 - 07.2023
Coordination of Benefits Supervisor II
Blue Cross Blue Shield of Massachusetts
01.2017 - 11.2022
COB Medicare Specialist II
Recovery & Provider Audit Blue Cross Blue Shield of Massachusetts
01.2015 - 01.2017
Reporting ANALYST
Claims Operations Blue Cross Blue Shield of Massachusetts
01.2014 - 01.2017
Coordination of Benefits SPECIALIST
Provider Audit Blue Cross Blue Shield of Massachusetts
01.2008 - 01.2014
High School Diploma -
Jeremiah E Burke High School