Berthena Brister, Mpc Email & Phone Number

Milwaukee, Wi, Us

United States

United States

Responsible for conducting investigations and interviews related to areas of compliance and privacy. Research and prepare risk assessments for. Maintain vendor contracts to ensure they administered according to the language of the agreement. Draft policies and procedures to ensure the third party claims administrator operate within the confines of the ERISA and ACA regulations. Conduct audits on operational guidelines and group plan compliance with federal and/or state regulations. Responsibilities also include conducting leader, employee, and healthcare provider conflict of interest surveys and create conflict of interest management plans when necessary.

Brookfield, Wi

Coordinate all aspects of regulatory audits Document, retain, report and clearly articulate audit findings to LeadershipWork with various internal groups to gather needed information for regulatory auditsWork with various departments to secure QHP application filing and product filings for the MarketplaceConduct state - specific legal researchMonitor changes in requirements to mitigate risks and achieve complianceSupport the collection of data for regulatory filingsCreate regulatory reporting and compliance calendarCoordinate updates to company policy and proceduresAssist with NCQA accreditation requirements

Research state and/or federal mandates to ensure product forms are in complianceAnalyze legislation and update our Mandate GridReview Benefit Spreadsheet to ensure they match the Mandate Grid for product buildsPrepare and file compliant policies, forms, and advertising materials with the Department of Insurance. Currently assigned to 7 states.Implement production forms based on the approved state filing formsMonitor and ensure annual filings/reports are completed in a timely fashion.Participate in market conduct examinationsMaintain product mandate grids (HMO, PPO, EPO)Participate and represent Product Compliance in Segment meetings Develop and foster relationships with internal business partners and Department of Insurance contacts

Represent Project department on small to medium size project/product implementations (i.e. system/field upgrades, workflow instructions, Customer Ops Intranet site)Maintain the Project Mailbox request (workflow link malfunctions)Participate in Project meetings to ensure Customer Operations workflows were in line with product or process launchesWorked closely with business partners to ensure targeted dates were metTraining and Development (Call Center

Greater Milwaukee Area

Train Call Center new hires on telephone system, computer system, Individual Medical claims and benefitsCreate training plans/modulesPerform quality audits for new hiresProvide refresher training Create call scenarios for on the job trainingParticipate in special projects as assigned

Answer customer calls (Agents, Providers, Insureds) regarding policy benefits and claim payments.Send referrals to appropriate areas to have processing errors correctedMaintain quality scores to ensure accurate and timely information was provided to callersResearch claim paymentsAssist with supervisor calls

Master Of Arts - Ma, Professional Communication

Bachelor Of Arts, Communication And Rhetorical Studies; Criminology And Law Studies

Diploma, General Education

Master Of Arts - Ma, Professional Communication