I would like to utilize my skills and abilities to help the organization achieve its goals and objectives. A dedicated worker that has the ability to effectively communicate with customers for the purpose of education, sales and marketing, and problem resolution. Also a person that is able to work independently or as part of a team to manage accounts and meet departmental goals. A worker that not only has drive but also has many years of experience in the health insurance setting. Other qualifications are:
- Group and Member Enrollment
- Training of staff
- Electronic Enrollment (834)
- Sales and Marketing Experience
- Presentation Skills
- Power MHS/AS400 15 years experience
- Customer Service Skills
- Application of various software
- Membership and Billing Reconciliation
PowerMHS, TestDirector, Winrunner, Quick Test Pro Microsoft Excel, Microsoft Access, Microsoft Word, PowerPoint, Lotus Notes, Visio, Sybase Compliance Tool, Ultra Edit, Envision, Quick Base, Blue Confidential, IPD, Macess, Mobius, Merck Medco System, Right Fax, EXTRA (LRSP), FACETS, QueryAS400
System Testing, UAT, Integration Testing, Disaster Recovery Testing, RegressionPROFESSIONAL EXPERIENCE
Confidential, North Carolina
Senior Business Analyst - Shared Services Department
- Serve as contact for Confidential System Support Benefits department, work collaboratively with all entities involved in the implementation as a liaison between vendor and ancillary carriers and internal Implementation team members.
- Coordinate with internal implementation team to create the necessary documentation utilizing the SDLC process
- Perform business analysis and support tasks to include production monitoring, Benefits file maintenance, ad-hoc reporting, and consultation with internal and external users .
- Participate in the analysis of existing business processes and systems, in order to recommend process and system enhancements to improve business performance and maximize the effectiveness of available technology.
- Assign and monitor tasks as scheduled maintaining project deadlines; identify risks which may jeopardize implementation/timelines
- Provide appropriate status/progress reports to all involved in implementation of project
- Create Benefit test files for the 834 EDI files
- Validate Benefit transaction file destinations using FACETS
- Use MS Access to analyze data
- Validate Benefit Data using MS Access by viewing SQL in Design View
- Compliance check all files using Sybase compliance checking tools before forwarding to technical team to execute file extraction/destination process
- Develop Benefit Test Scenario docs for tracking purposes
- Develop and Execute Benefit 834 Test Plans for all system modules. Update all related tracking documentation upon completion of file validation.
- Provide status of Benefit 834 testing Area during weekly department meetings
- Maintain written Benefit status reports for Testing area on an ongoing basis
- Work with team members and management team to review test result.
- Transition all completed conversion process to end user
- Reconcile Benefit membership information within FACETS
- Perform UAT and Regression Testing for system upgrades and the resolution of production system problems and configuration
- Coordinate and facilitate business participation in system upgrades and resolution of Benefit production problems
- Business Lead/Coordinator on projects: facilitate Project Request process, document business
Confidential, NORTH CAROLINA
Benefits Business Analyst II - Individual Business Confidential
- Responsible for and handling multiple projects
- Managed and worked with outside vendors and suppliers during the implementation stage
- Worked with IT and the PM to gather and verify Business Requirements
- Worked within Confidential with the SME’s to streamline the Process and Procedures for projects
- Worked with team members and management team to review test result.
- Reconciled membership and billing information
- Trained new employees on the Membership and Billing database
- Maintained the benefits database and assist with Group and Individual related issues
- Worked with both Group and Individual research issues that might be related to membership and billing.
- Performed UAT and Regression testing for system upgrades and develop and design test plans
- Facilitated the resolution of production system problems and configuration
- Coordinated and facilitated business participation in system upgrades and resolution of production problems
- Business Lead/Coordinator on projects: facilitated Project Request process, document business requirements
- Provided ongoing user support for Adhoc questions, inquires, and service requests.
- Consumer Directed Health, Health Savings Account HRA plans knowledge
- Knowledge of Electronic Data Transfer, and HIPAA 834 process
- Subject matter expert on the Power MHS, Vendor knowledge, Merck Medco, DBP dental vendor, Knowledge of AS400 Query and SQA robot
- Processed new and renewal Confidential request and entered Life applications into Power MHS.
- Assisted with upgrade and benefit change material for all group with complex benefits
- Determined appropriate GIS packages, and enter data on system as requested and handled all Monthly GIS reporting by the 5th of the month.
- Request missing material for information on master life application and enrollment material.
- Verified premium and rates to assure the quoted benefits have been implemented and responded to applicant telephone inquires, and providing timely follow-up on pending applications.
Human Resources Benefits Coordinator
- Administered and coordinated various benefits programs i.e. LTD/STD, Health and Dental, 401(k) and employee services to facilitate maximum effectiveness of Human Resources Department.
- Responded to employee inquires relating to benefits programs in a timely manner.
- Educate new employees about Sapiens benefits programs, policies and procedures.
- Enrolled employees in Corporate American Express and AT&T Calling Cards Program.
- Gathered and prepared employee news of quarterly newsletter.
- Monitor I-9 compliance documents.
- Maintained records and documents to assure compliance for COBRA, Section 125 and ERISA.
Confidential, North Carolina
Customer Service Trainer/Quality Assurance Specialist
- Assisted with ensuring all members of the Customer Service Department receive initial and ongoing training as it pertains to their job responsibilities.
- Assisted with the identification, development and implementation of necessary departmental training and assists with conducting quality assurance audits of the job functions.
- Coordinated initial training and testing of new Representatives. Provided ongoing training with existing Representatives.
- Trained on COBRA, HIPPA and the 125 Cafeteria Plan. Acted as the new hire team leader by monitoring attendance, progress, and by
- Provided feedback and maintained all Customer Service departmental training manuals.
- Assisted in training and QA for the Eligibility & Accounts Receivable Department
Team Leader/Enrollment Representative III, Member Enrollment
- Assisted in overseeing the day-to-day duties of 13 Member Enrollment Representatives and 1 Member Enrollment Clerk.
- Assisted the Manager in recruitment and development of the staff.
- Train the new and existing Representative on policies and procedures.
- Assisted in completing performance reviews for the staff.
- Responsible for data entry quality assurance audits on the Member Enrollment Representatives and the Clerk.
- Serve as a liaison to the Benefits Representatives
- Assisted the Member Enrollment Department with data entry as needed. Assisted with phone coverage as needed.
- Assisted in maintaining the membership database