Michelle Riley
Cumberland,MD
Summary
Care-oriented service professional with 22 years of customer service experience, including 15 years in health insurance at Florida Blue. Experienced in member advocacy and claims processing, utilizing critical thinking and active listening to resolve complex issues. Committed to enhancing customer satisfaction and streamlining support processes for optimal service delivery.
Overview
15
15
years of professional experience
Work History
Service Advocate
Florida Blue - Blue Cross Blue Shield Of Florida
Cumberland, Maryland
07.2019 - 04.2026
- Addressed claims, benefits, and enrollment inquiries.
- Advocated for members in claims disputes, submitted corrected information for adjustments.
- Assisted members with billing inquiries- addressing cycle frequency, start dates, and autopay.
- Educated members on self-service tools, assisted with troubleshooting technical problems, and provided documents upon request.
- Coordinated with other departments and vendors to provide a seamless member experience.
- Documented interactions, completed service requests and follow-ups, and monitored until resolution.
Customer Care Representative- Interim Assignment
ACS-Continuum
Frostburg, Maryland
04.2019 - 07.2019
- Provided customers with prescription claims/authorization status and prompt resolution.
- Documented customer interactions, created Rx refill orders, bill pay, and prior authorizations.
- Collaborated with team members to streamline support processes, improving response times for customer inquiries.
Customer Service Representative
ACS-Conduent
Frostburg, Maryland
05.2011 - 04.2019
- Addressed customer inquiries on claims, benefits, provider selection, authorizations, self-service tools, and more.
- Built customer trust through thorough issue management and follow-through to issue resolution.
- Experienced in de-escalation/ diffusion, promoting customer loyalty and satisfaction.
Education
Associate of Arts -
Allegany College of Maryland
Cumberland, MDSkills
- Customer Service Background, 22 yrs
- Heath Insurance Experience, 15 yrs
- Human Services Educated
- Claims processing and adjustments
- Policy exceptions and appeals experience
- Billing cycle, frequency, and automation experience
- Member advocacy
- Critical Thinking
- Active Listening
- Multi-System Experience
- Process improvement
- Needs responsive
- Self-Service Educator and Technical troubleshooting
Timeline
Service Advocate
Florida Blue - Blue Cross Blue Shield Of Florida
07.2019 - 04.2026
Customer Care Representative- Interim Assignment
ACS-Continuum
04.2019 - 07.2019
Customer Service Representative
ACS-Conduent
05.2011 - 04.2019
Associate of Arts -
Allegany College of Maryland