Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Shelley Kibiloski

Eaton Rapids,MI

Summary

Diligent health insurance representative with strong background in health insurance processes and client support. Successfully managed customer inquiries, claims processing, and policy interpretations, enhancing client satisfaction. Demonstrated proficiency in problem-solving and effective communication to ensure seamless service delivery.

Overview

15
15
years of professional experience

Work History

Case Management Coordinator

Physicians Health Plan
05.2020 - Current
  • Developed strong relationships with healthcare providers to ensure patient-centered care was consistently provided.
  • Identified potential barriers to successful outcomes, proactively developing action plans to mitigate risks or address challenges.
  • Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
  • Collaborated with providers and patients to obtain authorizations for needed services while minimizing out-of-pocket costs for patients.
  • Collaborated with employer groups and community partners to facilitate educational sessions outside of business hours.
  • Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
  • Worked well in a team setting, providing support and guidance.
  • Demonstrated respect, friendliness and willingness to help wherever needed.

Customer Service Specialist

Physicians Health Plan
08.2019 - 05.2020
  • Enhanced customer satisfaction by resolving issues promptly and professionally.
  • Responded to customer requests, offering excellent support and tailored recommendations to address needs.
  • Met customer call guidelines for service levels, handle time and productivity.
  • Actively participated in team meetings, continuously seeking opportunities to enhance skills and provide exceptional customer service.
  • Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
  • Collaborated with team members to develop best practices for consistent customer service delivery.
  • Participated in training programs to enhance product knowledge and customer service skills.

Credentialing Coordinator

Physicians Health Plan
11.2018 - 08.2019
  • Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
  • Conducted primary source verifications such as background checks and board certifications.
  • Received and evaluated applications to look for missing and inaccurate information.
  • Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
  • Updated and maintained accurate records in credentialing databases, ensuring timely renewals and verifications.
  • Skilled at working independently and collaboratively in a team environment.
  • Assisted with day-to-day operations, working efficiently and productively with all team members.
  • Passionate about learning and committed to continual improvement.

Senior Specialist

Physicians Health Plan
01.2011 - 01.2018
  • Established strong working relationships with clients through exceptional customer service and proactive communication efforts.
  • Followed all company policies and procedures to deliver quality work.
  • Developed training materials to enhance staff proficiency and productivity.
  • Enhanced customer satisfaction with timely and accurate issue resolution.
  • Self-motivated, with a strong sense of personal responsibility.
  • Paid attention to detail while completing assignments.
  • Assisted with day-to-day operations, working efficiently and productively with all team members.
  • Learned and adapted quickly to new technology and software applications.
  • Used critical thinking to break down problems, evaluate solutions and make decisions.
  • Developed and maintained courteous and effective working relationships.
  • Provided coaching and mentoring to new hires, contributing to their successful integration into the team.

Education

High School Diploma -

Eaton Rapids High School
05-1986

Skills

  • HIPAA compliance
  • Medical terminology
  • Insurance verification
  • Authorizations
  • Benefit coverage
  • Claim research
  • Patient care coordination
  • Customer service
  • Problem-solving
  • Can identify ICD-10, CPT & HCPC codes
  • Knowledgeable in Epic

Languages

English
Native or Bilingual

Timeline

Case Management Coordinator

Physicians Health Plan
05.2020 - Current

Customer Service Specialist

Physicians Health Plan
08.2019 - 05.2020

Credentialing Coordinator

Physicians Health Plan
11.2018 - 08.2019

Senior Specialist

Physicians Health Plan
01.2011 - 01.2018

High School Diploma -

Eaton Rapids High School