Michelle Jones

Compassionate, results-driven healthcare and customer service professional with more than seven years of experience in customer support, employee development, virtual facilitation, and performance coaching, complemented by experience as a Level II Claims Reviewer and Clinical Documentation Reviewer for Humana Military TRICARE East. Skilled in conducting medical records review, verifying clinical documentation within the MSR system, supporting referral approvals, adjudicating complex claims, and ensuring compliance with TRICARE guidelines and HIPAA regulations. Recognized for analytical problem-solving, attention to detail, collaborative communication, and building trusted relationships while consistently delivering exceptional service to beneficiaries, providers, and internal stakeholders.

Known for delivering exceptional customer experiences through active listening, problem-solving, and accurate documentation while maintaining the highest standards of confidentiality and professionalism. Currently pursuing a Master of Arts in Clinical Mental Health Counseling, further strengthening patient-centered communication, crisis awareness, and interpersonal skills that complement healthcare customer service and patient outreach while contributing to exceptional organizational outcomes.

Level 2A Claims Reviewer/ Clinical Documentation Reviewer - Tricare Humana Military

(2025-01)

Perform dual responsibilities as a Level II Claims Reviewer and Clinical Documentation Reviewer for Humana Military TRICARE East, conducting medical records review and clinical documentation verification within the MSR system to support referral approvals and medical necessity determinations. Review complex referrals, authorizations, and claims for accuracy, compliance, and policy adherence while collaborating with providers and internal teams to resolve documentation discrepancies. Ensure HIPAA compliance, maintain detailed electronic records, and provide exceptional support to beneficiaries, providers, and military families.

Corporate Training Coach - AFNI (Verizon Program) - Remote

(2021-01 - 2025-01)

• Facilitate engaging virtual instructor-led training for new Verizon employees while fostering confidence, accountability, and professional growth.
• Earned designation as a Verizon Certified Facilitator (September 2024) through demonstrated excellence in facilitation, learner engagement, and instructional delivery.
• Coach employees on communication strategies, customer service excellence, and effective problem-solving techniques.
• Build trust and rapport through active listening, empathy, and individualized coaching.
• Monitor quality assurance scores and KPI performance to improve employee success and customer satisfaction.
• Maintain accurate documentation of coaching sessions, learner progress, and performance outcomes.
• Collaborate with leadership to identify trends and implement strategies that improve customer experience.
• Mentor employees toward achieving performance goals while promoting accountability and continuous improvement.
• Consistently recognized for outstanding coaching effectiveness and exceptional performance.
• Ranked among the Top Two Corporate Training Coaches for departmental performance.
• Successfully facilitated hundreds of hours of live virtual training and coaching.
• Trusted to mentor new employees and support ongoing professional development initiatives.
• Recognized for delivering high-quality coaching that improved customer experience outcomes.

Service Desk Support Analyst - CNRG - Brewton, Alabama

(2019-01 - 2021-01)

• Delivered exceptional customer support through telephone and electronic communications.
• Assisted customers by identifying concerns, researching solutions, and providing timely resolution.
• Navigated multiple software systems while maintaining accurate customer documentation.
• Increased new account performance by 60% during the first quarter.
• Reduced operational costs by 30% through workflow analysis and process improvements.
• Increased sales by 45% through customer engagement initiatives and strategic communication.
• Supported administrative operations and records management.

Master of Arts - Clinical Mental Health Counseling - Liberty University

Bachelor of Science - Business Management - Indiana Institute of Technology

Associate of Applied Science - Office Administration - Coastal Community College