Nichole McElroy
Jonesboro,GA
Summary
Dynamic and results-driven customer service professional with extensive experience in the healthcare and insurance sectors. Committed to leveraging expertise to enhance organizational success while ensuring compliance with company policies. Eager to contribute to a forward-thinking company where professional skills can make an immediate impact as a vital team member. Passionate about delivering exceptional service and fostering positive client relationships.
Overview
14
14
years of professional experience
Work History
Client and Member Service Advocate
Imagine 360 Insurance
Atlanta, GA
10.2022 - Current
- Act as a liaison between clients, internal teams, and support organizations to manage escalations and ensure timely, effective issue resolution.
- Deliver high-touch member advocacy through proactive outreach, white-glove service, and comprehensive case management.
- Manage a caseload of members, guiding them through benefit navigation, billing inquiries, balance bill defense, and prior authorization processes.
- Respond to client and member communications with professionalism and urgency, collaborating with Client Services to ensure satisfaction.
- Review and explain billing statements and EOBs; support members with pre-service agreements, continuity of care, and appeals.
- Partner with CRM and legal teams to identify client success goals, align on action plans, and educate stakeholders on program guidelines and best practices.
- Maintain accurate documentation, analyze case data, and contribute to service and process improvement initiatives.
Customer Service Billing & Collection
WellStar
Atlanta, GA
01.2021 - 10.2022
- Handled high-volume inbound and outbound patient calls regarding medical billing, insurance claims, payment plans, and outstanding balances.
- Resolved complex billing issues and insurance discrepancies by reviewing Explanation of Benefits (EOBs), statements, and account histories.
- Collaborated with insurance providers to verify coverage, process claims, and assist patients with prior authorizations and appeals.
- Educated patients on billing procedures, insurance benefits, and available financial assistance programs with empathy and clarity.
- Processed payments, established payment plans, and ensured HIPAA compliance in all patient interactions.
- Maintained accurate documentation and case notes in billing systems and CRM tools, supporting smooth follow-up and resolution.
- Worked closely with revenue cycle, collections, and clinical teams to improve billing workflows and reduce patient frustration.
Customer Service Representative/Advocate
Peach State Health Plan
Atlanta, GA
01.2018 - 01.2021
- Served as a frontline representative and advocate for Medicaid and Ambetter members, providing accurate guidance on benefits, claims, authorizations, and provider access.
- Handled escalated member issues with urgency, empathy, and professionalism, ensuring resolution and follow-up while partnering with internal teams as needed.
- Assisted with training and mentoring new team members by sharing knowledge of systems, workflows, and effective member communication practices.
- Educated members on eligibility, coverage, billing, and appeals processes in compliance with CMS and state guidelines.
- Supported care coordination, appointment scheduling, and referrals to remove barriers to care and improve member outcomes.
- Maintained high-quality documentation in CRM and call center platforms, contributing to service consistency and audit readiness.
- Collaborated with claims, clinical, and case management teams to resolve complex issues and enhance the overall member experience.
- Remained up to date on plan policies, HIPAA compliance, and program updates to ensure accurate information delivery.
Customer Service Representative
United HealthCare
Atlanta, GA
01.2016 - 01.2017
- Assisted Medicare Advantage and Part D members with benefit inquiries, claims, coverage, and provider network questions.
- Managed escalated issues, ensuring timely resolution while adhering to CMS and HIPAA compliance standards.
- Educated members on Medicare-specific processes, including billing, pre-authorizations, and appeals.
- Utilized Medicare systems to verify eligibility, research claims, and update member records accurately.
- Supported new hires with Medicare plan training and best practices for member communication.
- Collaborated with internal teams to resolve complex cases and improve member experience.
Medical Receptionist
Spine and Orthopedic Pain Management Clinic
Jonesboro, GA
01.2012 - 01.2016
- Registered patients for in office services, made appointments, and schedule procedures
- Verified insurance for claims processing, read EOBs to ensure insurance applied correctly posted insurance payments to patient’s accounts
- Maintained medical records, read dictations, received MRI reports, and patient MARS
Education
High School Diploma -
Carver High School
Columbus, Georgia2002
Skills
- Time Management
- Account Management
- Problem Solving
- Detailed Oriented
- Integrity & Trust
- Leadership
- Teamwork
- Organizational skills
- Effective communication
- Adaptability and flexibility
- Interpersonal skill
- Microsoft office
- Data entry
Systems & Software
Salesforce, CTDynamo, Macess, GBAS, Zelis
Microsoft Office Suite (Word, Excel, Outlook, PowerPoint, Teams)
Medicaid CRM, OMNI, Amisys, Rain Tree software, Management Plus software, Epic
Timeline
Client and Member Service Advocate
Imagine 360 Insurance
10.2022 - Current
Customer Service Billing & Collection
WellStar
01.2021 - 10.2022
Customer Service Representative/Advocate
Peach State Health Plan
01.2018 - 01.2021
Customer Service Representative
United HealthCare
01.2016 - 01.2017
Medical Receptionist
Spine and Orthopedic Pain Management Clinic
01.2012 - 01.2016
High School Diploma -
Carver High School