Michele Stone
@michelestone
Seasoned customer care professional seeking Claims Examiner role.
What I'm looking for
As a seasoned customer care professional with 6 years of experience in the insurance industry, I have honed my skills in handling complex issues, navigating insurance databases, and providing detailed benefits and eligibility information. My proven track record of maintaining high customer service metrics and resolving claims-related inquiries effectively has earned me a reputation as a reliable and efficient professional.
In my current role at Optum - United Healthcare, I have demonstrated my ability to document customer interactions comprehensively and resolve complex inquiries by researching multiple databases and collaborating with support teams. Previously, I have worked with Anthem Blue Cross, Medicaid, and California State Long Beach, where I addressed customer inquiries, facilitated communication, and resolved payment discrepancies.
With a strong educational background in Psychology and Child Development, I possess a unique understanding of human behavior and development. I am confident in my ability to bring value to a Claims Examiner role, leveraging my skills in customer service, case management, and medical terminology to drive results.
Experience
Work history, roles, and key accomplishments
Member and Provider Service Representative
Anthem Blue Cross
Oct 2021 - Feb 2022 (4 months)
Addressed customer inquiries and facilitated communication regarding insurance coverage, claim statuses, and digital portal assistance.
Customer Care Professional
Optum - United Healthcare
Feb 2023 - Present (2 years 3 months)
Resolved complex inquiries by researching multiple databases and collaborating with support teams to provide accurate benefit, eligibility, and referral information.
Medicaid Customer Care Representative
GBD LTSS Cal AIM
Resolved customer inquiries and billing discrepancies to ensure account accuracy.
Professor Assistant
California State Long Beach
Feb 2017 - May 2017 (3 months)
Assisted with grading papers, maintaining attendance records, and managing research documentation to support academic processes.
Education
Degrees, certifications, and relevant coursework
Michele hasn't added their education
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