Enrollment Supervisor Resume Enrollment Supervisor - Hire IT People

SUMMARY

25 years of in - depth experience in the health insurance industry
Extensive experience in eligibility processes, claims operations, quality assurance auditing, and medical benefits.
Vast knowledge of working with benefits (both self-funded and commercial), payment methodology and how they apply to claims, accumulators, deductibles, coinsurance, OOP and lifetime maximums
Diversified quality driven and technology professional with focus on increasing productivity and customer satisfaction through collaboration and process improvement
Flexible, adaptable and goal-driven
Customer focused; effective liaison with internal and external customers
Passionate, results-oriented, high energy, quick learner, and self-starter
Strong written and oral communication skills
Detail oriented, organized and thorough documentation habits
Effective time management, organization and prioritization skills with excellent work ethic
Analytical and troubleshooting skills

PROFESSIONAL EXPERIENCE

Enrollment Supervisor

Confidential

Responsibilities:

Implementation of New COBRA platform by Travisoft
Responsible for eligibility on 7 individual platforms according to line of business; PowerMHS,Eldorado HEALTHpac, HealthEdge HealthRules, Travisoft, PayDirect, 1Cloud, P&W
Responsible for overseeing and prioritizing individual workload and team goals
Developed and implemented the Enrollment QA Program
Maintenance of accurate member files for enrollment and eligibility
Accountable for COBRA administration according to DOL regulations and guidelines
Effectively create synergy in my department and between departments for success as a whole
Train and support the current team and new associates
Handle escalations and research eligibility issues or electronic file problems
Conduct semi-annual reviews and address performance issues
Partner with IT to load eligibility data files into production and identify data issues
Ability to juggle workload, make decisions, adapt and respond quickly to business needs
Maintain a team culture with open lines of communication, help, feedback, coaching and support
Internal and external collaboration to provide insight and knowledge to staff and departments
Identify team strengths, weaknesses and motivations

Quality Assurance Team Leader

Confidential

Responsibilities:

Successfully created a synergistic culture in my department and between departments
Trained and supported all team members
Managed individual workloads and team goals to continuously meet service levels
Handled daily audits, special audits, reporting, end of month reporting, call monitoring
Implemented and transitioned our home grown QA claims auditing system to ACL Analytics process
Transitioned QA auditing into new claims system
Identified major issues and provided resolutions during the implementation of new scripting for the daily QA import
Identified data issues and manually manipulated as needed to ensure accurate reporting and workflow in the department
Responsible for Appeal and HIPAA auth process
Responsible for check write process and approval