OBJECTIVE

• I have over 20 years Customer Service experience and I am a self - motivated, outstanding team player with strong organizational and planning skills.
• I have excellent verbal and written communication skills, strong analytical skills and excellent presentation skills and a fantastic change agent.

TECHNICAL SKILLS

• MS Office applications, Access, Project, Outlook, Explorer
• Knowledge of SAS reporting
• Completed Six Sigma Yellow Belt training
• Completed LEAN Level 1

PROFESSIONAL EXPERIENCE

Confidential, Jacksonville, FL

Group Premium Specialist

Responsibilities:

• Billing administration for employer groups and individuals in National Accounts
• Audit group and individuals payments, payment processing and delinquency using excel
• Genelco file maintenance by maintaining accounts and terming and reinstating employees
• Prepare audits when necessary for group or individual using billed verses paid and working to reconcile the accounts using a master recon on excel
• Research outstanding balances, payments and discrepancies to ensure payment and bill match
• Research multiple systems to track flow of funds to ensure proper distribution
• Maintain positive relationship with Account reps to work through payment and account maintenance

Confidential, Jacksonville, FL

Responsibilities:

• Work closely with executive accounts to maintain and process orders through E-commerce, Price Lists, Websites, Customer Support and assisted Suppliers.
• Identify, monitor and resolve potential problematic customer issues upfront including service failures
• Maintain open lines of communication with external and internal customers and focus on solving a range of challenges presented by analyzing potential solutions using standard operating procedures
• Create and manage quotes to customers via established policies, upsell, cross sell and substitute items to earn customer loyalty and retention. Worked directly with suppliers to determine pricing and availability

Confidential, Jacksonville, FL

Service Advocate

Responsibilities:

• Lead team of 15 people to rewrite and implement Medicare procedures
• Lead a team tasked with rewriting the HIPAA Disclosure Guidelines for Enrollment & Billing to improve the process of authentication of members for Service Advocates to properly validate appropriate information that is being provided within the HIPAA Laws
• Processing group employee enrollment. Take incoming calls from Human Resource Managers to assist in resolving member enrollment or billing issues
• Trained Benefit and HR personnel on how to enroll and process changes on Blues Enroll website set up for groups that chose to process their own enrollment
• Manage group (Benefit Administrators, Agents and Human Resources staff) financial reconciliation that are not paying premiums within the time frames outlined in their insurance contract by coordinating with both internal and external stakeholders to ensure timely reconciliation of premiums to avoid using appropriate collections procedures for groups 1-5000+ employees
• Analyze data provided by groups to make necessary modifications to member payment history to decrease overall loss at year-end
• Initiate changes to Automated Enrollment for groups by testing processes to the group electronic enrollment to eliminate errors to decrease reworks. Worked all discrepancies back with the Group, Vendor or Third Party Administrator
• Knowledge and experience with COBRA benefits, coding and processing COBRA files to ensure timely COBRA elections and enrollment for qualifying events, new hires and terminations and COBRA billing. Worked back with Third Party Administrator or and or Vendors to ensure corrected information was being sent over
• Manage positive relationships with Benefits Administrators, Decision Makers, Agents and Broker
• Extract monthly high cost claims report for ASO stop loss groups to identify high claimants and extract member claims detail report to file stop loss claims
• Analyze, validate, and interpret supporting healthcare information and claims from various systems to ensure accurate and timely claims processing
• Audit enrollment, and billing functions for Group and Individual market to ensure compliance with all State and Federal Laws
• Provide timely, accurate and objective audit feedback fostering process improvement opportunities to frontline staff to ensure high quality customer service by attending Staff meetings to share findings for necessary feedback. Provide one-on-one coaching and continuous education to front line staff
• Provide analytical support in trending, analysis and weekly quality reporting to leadership staff with recommendations for coaching to eliminate performance problems.
• Document audit results in appropriate systems for validation through Quality Review Board
• Perform service observations on incoming telephones calls for Quality Assurance
• Complete Calibration sessions, Quality Auditor and peer training
• Identify and communicate barriers that could impact individual and or team goals and make recommendations on process improvements for training and development to leadership
• Wrote and implement several standard operating procedures for use by new quality auditors as well as created process improvements for Membership and Billing

Confidential, Jacksonville, FL

Office Manager/Bookkeeper

Responsibilities:

• Processed payroll for employees through Quicken Program
• Monitored and validated employees worked time
• Developed invoices for accounts payable
• Monitored Delinquency with accounts and implemented collections procedures to obtain money
• Monitored accounts receivable and tracked in Quicken Program
• Analyzed job costs, created excel spreadsheet to track total costs of each job completed
• Typed and processed invoices, letters and proposals for clients
• Answered phones and assisted clients
• Created a general ledger to manage costs of various office expenses
• Researched and gathered appropriate tax information to provide to the company’s Certified Public Accountant