Customer-focused pro who is passionate and dedicated in giving back to my community with proven ability to effectively manage clients, customers, and projects. Strong, independent, highly adaptable worker looking to apply strong leadership, communication, and administrative skills.
Respond to incoming calls from members and providers as required to meet department goals. Including explaining benefits, eligibility, provider status, workflows, guidelines, services and other necessary information.
REGENCE (Contract Work)
Jul 2014 - Dec 2014
Benefit Compliance Coordinator
Maintain records and files of work and revisions using Microsoft Excel and Microsoft Word. Create Summary of Benefit Changes, pre-sales documents, used for quoting Medical Plans to potential clients. Edit, standardize, or make changes to material prepared by other writers or established personnel. Analyze developments in specific field to determine need for revisions in previously published materials and development of new material using Adobe Reader Pro. File written Contracts and amendments with the Office Insurance Commissioner. Special projects or other duties as assigned.
COMMUNITY HEALTH FIRST MEDICARE ADVANTAGE
Oct 2012 - Jun 2014
Customer Service Representative
Respond accurately and courteously to member and provider inquiries regarding benefit s, eligibility, claim status, and accessing care through plan providers.
Provide information and coordinated appropriate resolution of issues and complaints.
Document inquires, complaints, phone hospital notifications, and other data in Windows computer database with strong attention to detail.
Provide back-up as needed to other positions and functional areas such as Eligibility and urgent Prescription updates for the Caremark Pharmacy Team.
HEALTHCARE MANAGEMENT ADMINISTRATORS
Oct 2008 - Apr 2012
Enrollment Specialist/Customer Service Rep II
Part of special Continuous Quality Team which met every week to discuss any major changes due to Health Care Reform and Federal/State Mandates.
Update policies and procedures to assist the Customer Service Team in providing consistent and accurate benefit information as well how to resolve and other issues and complaints.
Serve as the primary contact for all eligibility and enrollment matter for all assigned clients and their brokers working closely with the Human Resources department.