Michele Howard
Buckeye
Summary
Detail-oriented customer service professional with extensive experience in insurance verification. Successfully manages high-volume workloads while collaborating with cross-functional teams to resolve complex cases. Committed to maintaining compliance and accuracy in a fast-paced environment.
Overview
15
15
years of professional experience
Work History
Insurance Specialist
McKesson
Scottsdale
01.2022 - Current
- Conduct detailed insurance investigations by contacting commercial, Medicare, Medicaid, and managed care payers to verify patient coverage, benefits, eligibility, and authorization requirements.
- Researched and analyzed insurance information to facilitate patient access to prescribed therapies and healthcare services.
- Identify prior authorization, referral, and payer-specific requirements that may impact treatment access and reimbursement.
- Resolved insurance-related discrepancies by collaborating with payers, provider offices, and internal departments to ensure accurate coverage.
- Maintain accurate documentation and case records while adhering to company policies and compliance standards.
- Independently manage a high-volume workload while meeting quality, productivity, and service expectations.
- Assist team members during annual re-enrollment periods by providing guidance on insurance changes, payer requirements, and program processes.
- Support new and existing team members through chat assistance, answering questions related to benefits investigations, insurance verification, and case processing.
- Partner with leadership and peers during training and onboarding activities to help reinforce program workflows, documentation standards, and best practices.
- Serve as a reliable resource for teammates by sharing knowledge, providing real-time support, and helping maintain operational efficiency during peak business periods.
- Collaborated with cross-functional teams to address complex case scenarios, ensuring timely patient access to therapy.
Insurance Specialist
RemX
Scottsdale
01.2021 - 01.2022
- Conduct detailed insurance investigations by contacting commercial, Medicare, Medicaid, and managed care payers to verify patient coverage, benefits, eligibility, and authorization requirements.
- Research and analyze insurance information to support patient access to prescribed therapies and healthcare services.
- Identify prior authorization, referral, and payer-specific requirements that may impact treatment access and reimbursement.
- Resolve insurance-related discrepancies through collaboration with payers, provider offices, and internal departments.
- Maintain accurate documentation and case records while adhering to company policies and compliance standards.
- Independently manage a high-volume workload while meeting quality, productivity, and service expectations.
- Assist team members during annual re-enrollment periods by providing guidance on insurance changes, payer requirements, and program processes.
- Support new and existing team members through chat assistance, answering questions related to benefits investigations, insurance verification, and case processing.
- Partner with leadership and peers during training and onboarding activities to help reinforce program workflows, documentation standards, and best practices.
- Serve as a reliable resource for teammates by sharing knowledge, providing real-time support, and helping maintain operational efficiency during peak business periods.
- Collaborate across teams to resolve complex case scenarios and support timely patient access to therapy.
Telephonic Interviewer/Licensed Agent
LTCG
05.2013 - 05.2020
- Conducted medical interviews for high dollar life and long-term care policies, ensuring thorough understanding of client needs
- Scheduled appointments for policy applicants, streamlining the application process
- Built trust-based relationships through open and interactive communication, enhancing client satisfaction
- Documented customer interactions to ensure accurate records.
Customer Service Representative
UNITED HEALTH GROUP
08.2011 - 01.2013
- Taking inbound calls from providers to verify coverage for patients
- Processed overrides for prescription medications to ensure patient access to necessary drugs.
- Followed up with providers regarding invoice disputes to ensure timely resolution and maintain provider relationships
- Maintained accurate records of customer interactions to support service quality and follow-up actions
- Process customer accounts and file documents
- Follow communication procedures, guidelines and policies
- Handled complaints, provided appropriate solutions and alternatives within time limits, and ensured follow-up for complete resolution
- Provide accurate, valid and complete information by using the right methods/tools
- Identify and assess customers' needs to achieve satisfaction
Education
GED -
AZ College of Allied Health
Phoenix, AZ05-2011
Skills
- Insurance verification
- Insurance Regulations
- Data documentation
- Clerical/Office
- Customer Service
- Team collaboration
- Attention to detail
- Problem solving
Timeline
Insurance Specialist
McKesson
01.2022 - Current
Insurance Specialist
RemX
01.2021 - 01.2022
Telephonic Interviewer/Licensed Agent
LTCG
05.2013 - 05.2020
Customer Service Representative
UNITED HEALTH GROUP
08.2011 - 01.2013
GED -
AZ College of Allied Health