- Senior level Insurance Benefit Analyst with excellent knowledge in Medicare, Medicaid, COBRA & Commercial Insurance enrollment. Excellent leadership skills and able to utilize those skills to assist benefits teams to excel and adopt best practices.
- Medicare/Medicaid/Commercial Insurance/COBRA/Third Party Insurance
- Process Improvement
- MS Office/MS Project
- Produce and complete SBC’s and SPD’s for internal clients and external clients
Benefit Implementation Specialist
- Managing tasks assigned to client and business partners to keep them on track
- Lead pre - implementation calls with internal team members and business partners
- Perform implementation calls with internal team members and client
- Attend weekly benefits meetings to review pipeline
- Work with 3rd party enrollment team to provide details, resulting in increased adoption
- Maintain knowledge of requirements, regulations and compliance of benefits plans, such as life, health, dental, vision and disability
- Responds to inquiries regarding policies, procedures and programs
- Confidently lead and drive progress for a successful and speedy implementation. These are template and checklist driven repeatable processes
- Manage client expectations throughout the enrollment process
- Work proactively to facilitate solutions as challenges present themselves
- Maintain open communication regarding client with necessary departments and business partners
- Dashboard creation of employee facing electronic enrollment platform
- Acting as part of a team to continually develop and create improved processes and procedures
- Prepare and distribute weekly update of benefits implementation activities
- Other related duties, as assigned
- Responsible for company level setup to ensure compliance with ACA regulations.
- Lead and assist team in conducting detailed research and data analysis on ACA data and customer issues. Facilitates problem escalations and either resolves them or escalates them to the appropriate level for resolution.
- Lead and assist with information gathering for annual filings, measurement period, eligibility determination, compliance testing, government filings, and other duties related to year-end processing.
- Coordinates ACA for year-end process with customer to ensure compliance with the Affordable Care Act and reports findings to Customer and client.
- Lead and assist Benefits department with maintenance and tracking of all legally required documentation in accordance with IRS/DOL requirements, including timely distribution to employees.
- Perform other job-related duties as assigned or apparent.
- Serve as back-up to Director of Software Support and Account Managers by responding to their telephone calls from clients, emails, or other forms of communication.
- Escalate client service issues to management as necessary.
- Liaison between all internal business partners on behalf of the client
- Administered health and welfare benefit plans, including enrollments and terminations.
- Assisted with client’s new employee integration and deductions including setting up benefits, 401k plans and additional deductibles in HRP & Prism Systems
- Processed insurance enrollments, terminations, and assist with the administration of COBRA
- Conducted audits for accuracy
- Performed benefits claim resolution and administration
- Reviewed and managed benefits eligibility and deduction information, and review interface reports between payroll software system (Davison/HRP), Payroll Department and carriers
- Monthly billing reconciliation for various carriers
- Created and uploaded 401k contribution files
- Investigated and resolved any discrepancies
- Assisted with discrimination testing, SPDs, Plan Amendments, Plan Document updates
- Assisted with disability paperwork and OSHA recording
Benefits Enrollment Trainer
- Designed and/or prepare training/instructional materials, teaching aids and devices; on occasion involving coordination with other departments.
- Created and updated training agendas, materials, including written and recorded demos for Customer Service, COBRA, Enrollment and Billing departments.
- Effectively trained customer service representatives for handling calls from members regarding plan coverage, account status, claims and eligibility in a prompt, professional and courteous manner.
- Identified opportunities for improvement and implement best practices moving forward.
- Coached and re-trained individual team members as specific areas for improvement are identified.
- Handled escalated scenarios in an effective and timely manner abiding by company policies and procedures
- Provided employee performance feedback to management based on course assessments in support of employee and staff development.
- Generated 1094 and 1095 for clients.
- Strong knowledge of ACA, ERISA, and ADA
- Handle inbound enrollment transactions received electronically, web portal and via hard copy
Senior Benefits Specialist
- Served as a SME in the areas of medical, dental, life insurance, pension, 401K, payroll, retirement plans and disability insurance. Strong knowledge of benefits terminology, plan design, and claims resolutions including FSA, HRA, and explanation of benefits.
- Consulted to leadership regarding daily client requirements and compliance.
- Identified and created process improvements to internal staff and external clients which positively impacted team performance.
- Contributed to resolving complex account issues including research and responding to standard inquiries from various departments.
- Communicated potential issues to the appropriate parties to prevent client escalations.
- Team Lead on projects for COBRA and Medicare
- Assisted with reviewing/approving employees with questions when taking a leave of absence or FMLA