Health Insurance Specialist
Responsible for performing contractor oversight for five HMO / PDP plans in Region II. Assisted in the implementation of the new Medicare Modernization Act by reviewing bids from contractors in 2005. Provided guidance to the Director and other Administrators on out-of network benefits, monitoring / auditing and PDP litigation. Reviewed marketing materials for both MAPD and PDP plans. Selected to participate in several National workgroups with Booz Allen and Central Office. Designed and implemented training programs for PDP’s to improve their customer service performance. Advised Medicare stakeholders, contractors and beneficiaries on grievance, appeals claims and enrollment. Represented Region II on a bi-weekly conference call with United / AARP discussing national complaints and issues. Trained a new member of the department on CMS guidance pertaining to marketing review materials. Selected to speak twice before the Medicare Rights Center, on PDP and Marketing Guidance. Researched complex PDP issues like formulary complaints, low income subsidy (LIS) and employer group issues in the F.R., C.F.R., CMS Marketing guidelines and on Lexis. Worked closely with CMS caseworkers that elevated complaints that were to complex and they could not resolve.