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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:

  • Provide quotes for personal property and personal auto insurance
  • Collect and record necessary customer information
  • Respond to customer questions and concerns
  • Input, maintain and follow-up on clients and prospected clients insurance needs
  • Assist clients in reporting claims

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

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