Client Benefit Analyst Resume

SUMMARY:

Experienced Leader in the pharmacy benefits management setting.
Two years experience as a supervisor with experience in training, managing and motivating staff.
Ability to engage in multiple projects with tight deadlines.
Detail oriented, proficient in multi - tasking, problem solving and accustomed to a fast paced environment.
A team player but also works well independently.

TECHNICAL SKILLS:

Computer literate in: MS Word, Excel and Power Point.

PROFESSIONAL EXPERIENCE:

Confidential

Client Benefit Analyst

Responsibilities:

Analyze client benefit requests to determine client intent for benefit plan design
Research issues and recommend alternative solutions based on client need
Provide consultation to clients and internal partners during new business implementation
Coordinate with internal partners to ensure the appropriate documentation is received
Responsible for meeting or exceeding turnaround time and quality standards

Confidential

Supervisor Medicare

Responsibilities:

Review of prior authorization and appeals for Confidential enrollees
Supervisor of 34 technicians performing reviews for coverage determinations and appeals
Ensure policies and procedures as well as CMS regulations are followed
Project management with multiple teams across multiple site locations
Conduct audits and coaching for quality and assurance
Develop new policies and procedures to increase efficiency
Daily troubleshooting of complex issues

Confidential

Lead Representative

Responsibilities:

Review of prior authorization and coverage determinations for Confidential and commercial enrollees
Provides support to the Appeals Department in meeting clients' expectations regarding efficiency, service levels, privacy maintenance and quality of decision-making
Trained pharmacists and technicians
Create process workflows and work instructions

Confidential

Senior Customer Service Specialist

Responsibilities:

Handle complex or escalated calls from customers regarding online accounts
Perform routine account-related transactions such as opening new accounts, completing the online account set-up process, account maintenance and completing wire transfers

Confidential

Customer Service Representative

Responsibilities:

Confidential

Operations Service Technician

Responsibilities:

Supervise workflow and daily activities for RI personal property and personal auto team
Train new employees for RI personal property and personal auto team
Pre-underwrite and code new business and endorsements for RI personal property and personal auto team
Assist underwriters in evaluating new business personal property and liability risks for acceptance or denial in accordance with company underwriting guidelines and philosophies