Michelle Young
Columbus
Summary
With a diverse background in documentation analysis, legal compliance and customer service, I am looking to continue to grow my expertise. My track record includes, but is not limited to, being the first impression for clients as well as managing company administrative and operational needs. My goal is to continue to facilitate opportunities for client satisfaction as well as company goals.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Claims Compliance Specialist
Aflac
Columbus
11.2024 - Current
- Reviewed compliance policies and procedures for alignment with regulatory standards.
- Developed training materials for staff on compliance regulations.
- Conducting internal review audits to ensure adherence to company, state and Department of Insurance guidelines.
- Prepared reports summarizing compliance findings and recommendations for management review.
- Collaborated with cross-functional teams to address compliance issues effectively.
Claims Specialist III, Multiline
Aflac
Columbus
10.2021 - 10.2024
- Processed insurance claims efficiently and accurately for policyholders.
- Communicated with clients to gather necessary documentation for claims submission.
- Reviewed claim files to ensure compliance with company policies and regulations.
Claims Specialist II, Disability
Aflac
Columbus
06.2021 - 10.2021
- Utilized claims management software to track and manage claim status effectively.
- Evaluated disability claims to determine eligibility and compliance with regulations.
- Collaborated with healthcare providers to obtain additional medical records as needed.
- Documented claim decisions and maintained accurate records in the system.
Claims Specialist I, Accident
Aflac
Columbus
09.2019 - 06.2021
- Efficiently and effectively process a large volume of medical Accident claims on a daily basis.
- Provided mentor sessions for employees in training as well as peers.
- Investigate and analyze validity and compliance of claims to improve timeliness of claims status to customers.
- Input data into the payment system, ensuring that provider coding information and reported services were correct.
- Actualized strategies to continuously improve claims processing by helping add new criteria to processing manuals, system improvements, as well as participating in various focus groups.
- Assisted with Aflac Group Premium Processing project "Mission Possible" in order to reach the June Premium goal for Policy Service. The contributions applied to the highest amount of premium in Aflac history at 68 million.
Education
Bachelor of Science - Business Administration
Columbus State University
Columbus, GA05-2023
Associate of Science - Business Administration
Middlesex Community College - Middletown
Middletown, CT06.2013
Skills
- Adaptability & Interpersonal Skills
- Business Process Analysis & Implementation
- Training Colleagues and Management
- Proficient in Microsoft Office
- Data Assessment & Analysis
- Operational Improvement
- Mentoring Colleagues
- Effective Time Management
- Action Oriented
Accomplishments
- Policy Service Aflac Group Premium Project "Mission Possible," May-June 2020
- Business Operations Processing Manual updates, April 2020
- Selected Ideas for Pega System integrations, February 2020
- Worked on P44 team to spearhead new claims system for all of claims department May 2022-August 2022
- Trained supervisors and specialists in groups and one-on-one to teach the new claims system June 2022-August 2022
- Disability call project October 2023-December 2023
- Critical team assistance project January 2024-Current
Certification
- Lean Six Sigma White Belt Certification received May 2023
Timeline
Claims Compliance Specialist
Aflac
11.2024 - Current
Claims Specialist III, Multiline
Aflac
10.2021 - 10.2024
Claims Specialist II, Disability
Aflac
06.2021 - 10.2021
Claims Specialist I, Accident
Aflac
09.2019 - 06.2021
Bachelor of Science - Business Administration
Columbus State University
Associate of Science - Business Administration
Middlesex Community College - Middletown