Michelle L. Brown
Enfield,CT
Summary
Independent and self-motivated professional with proficient communication and writing skills. Experience working in fast paced professional environments with the ability to grow positive relationships with customers and colleagues at all organizational levels. Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering three years of insurance experience.
Overview
22
22
years of professional experience
Work History
Claims Advocate
Cigna
08.2023 - Current
- Negotiated favorable settlements for clients by thoroughly investigating claims and presenting strong evidence.
- Reduced customer complaints by providing timely and accurate updates on claim status.
- Balanced the interests of both insurance companies and clients in claim negotiations, ensuring fair outcomes for all parties involved.
- Identified opportunities for process improvements, leading to reduced errors in claim submissions.
- Enhanced client satisfaction by regularly following up on open claims and providing progress reports.
- Participated in ongoing professional development opportunities to stay current with industry trends and best practices for claims advocacy.
- Managed sensitive client information with strict confidentiality, adhering to data protection laws and guidelines at all times.
- Maintained comprehensive knowledge of industry regulations and guidelines, ensuring compliance in all aspects of claim handling.
- Provided exceptional customer service to clients during stressful situations, earning positive feedback from satisfied customers.
- Advised internal teams on proper documentation procedures, reducing instances of missing or incomplete information that could delay claim resolution times.
- Assisted clients in understanding policy coverage and benefits, resulting in better-informed decisions about their claims.
- Managed a large caseload of claims, ensuring prompt attention to each case and maintaining organized records.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
Administrative Assistant
Loading Doc Central, LLC
07.2022 - Current
- Scheduling and managing schedules for employees;
- Write and distribute emails, correspondence memos, letters, faxes and forms;
- Maintain a filing system;
- Submit and reconcile expense reports to ensure that accounts payable invoices are paid timely;
- General bookkeeping duties, including creating customer invoices and posting information into a Quickbooks software to maintain client accounts.
Customer Service Advocate
Cigna
10.2021 - Current
- Responsible for answering a high volume of incoming calls and customer service inquiries from current members, providers, internal and external business partners and seeing those calls to completion;
- Assisting members and providers with correspondence, appeals, claims adjustments, dental benefits, and all other information needed to properly adjust their claims;
- Adhering to HIPPA guidelines;
- Meeting outlined performance goals established for the position, such as productivity, call quality and customer satisfaction;
- Utilizing appropriate resources to effectively and efficiently and accurately interpret, respond and resolve customer inquiries and problems
- Understanding plan information and contracts in order to effectively interpret the information relating to the plans benefits to members and providers
- Demonstrates strong interpersonal skills in order to handle difficult calls courteously and professionally.
Waitress
Red Robin
10.2017 - 01.2022
- Works as part of a team that includes managers, hosts, and bar tenders;
- Works as a team member to achieve the highest level of customer service;
- Work in accordance with all health and safety standards to promote wellness and enjoyable customer experiences;
- Professional and polite under all circumstances;
- Works quickly and efficiently in busy environments and having to juggle multiple tasks
- Responding appropriately to customer inquiries, comments and complaints to improve customer satisfaction.
Waitress / Host
Ruby Tuesday
01.2003 - 09.2017
- Responsible for welcoming guests to the restaurant and promoting the food and beverage menus;
- Working as a team to keep the work environment clean and organized;
- Responsible to provide efficient, expedient and courteous service to guests to ensure an optional experience
- Received in-depth training for proper food handling techniques, including proper freezer placement, appropriate soup temperatures, and equipment cleaning processes.
Education
Some College (No Degree) - Criminal Justice
Briarwood College
Southington, CTSkills
- Proficiency in
- Microsoft Office Suite – Word, Excel, PowerPoint; Microsoft Teams and Skype
- 10-Key Proficiency
- Data Entry Documentation
- Process Optimization
- Document Retrieval
- Customer Service
- Self Starter
- Time Management
- Performance Improvement
- Multi-Line Phone Systems
- Complex Problem-Solving
- Internal Communications
- Insurance Eligibility Verifications
- Customer Relations
- Critical Thinking
- Phone Call Answering
- Typing Proficiency
- Office Management
- Reading Comprehension
- Schedule Management
- Bookkeeping
- Prioritization
- Filing
- Microsoft Word
- Database Management
- Active Listening
- Accounts Payable and Accounts Receivable
- Team Meetings
- Intuit QuickBooks
- Filing Appeals
- Accurate Documentation
- Claims Procedures
- Policy Requirements and Eligibility
- Policy and Procedure Explanations
- Insurance Coverage Limits
- Insurance Terminology
- Claims Investigation
- Claims analysis
- Policy Interpretation
- Insurance Claims Review
- Decision-Making
- Flexible Schedule
Timeline
Claims Advocate
Cigna
08.2023 - Current
Administrative Assistant
Loading Doc Central, LLC
07.2022 - Current
Customer Service Advocate
Cigna
10.2021 - Current
Waitress
Red Robin
10.2017 - 01.2022
Waitress / Host
Ruby Tuesday
01.2003 - 09.2017
Some College (No Degree) - Criminal Justice
Briarwood College