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Resume

Enrollment, SupervisoR

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

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