Benjamin Desmit Email & Phone Number

Enrollment, Billing and Reconciliation operations leader.

Operational readiness and implementation leader. Specializing in Individual ACA and Medicare insurance. Expertise includes Sales, Web and mobile channels, Enrollment, Customer Service, Claims, Medical Management, Appeals and Grievances, Provider networks, Reconciliation, Finance, Billing, Risk Adjustment, EDGE server, and Regulatory reporting.

Naperville, Il

On/Off ACA Exchange enrollment processing providing significant contributions to the development of Enrollment Business Rules, 834 and Enrollment processing including the identification of defects and troubleshooting workarounds for operations. Key activities include Automated Control monitoring, Enrollment Reconciliation with CMS, and Operational support with tools to bridge gaps between IT-supported system functionality and business needs. Designed and built Enrollment and Financial Recon capabilities from the ground up within HCSC. Led back-office teams responsible for enrollment, billing, and membership operations. Achieved 80% reduction in enrollment and financial discrepancies while implementing a repeatable process to resolve data discrepancies. CMS Liaison for HCSC in the CMS Alpha workgroup and operations lead with CMS regulators. Led the Enlighten (Operational Excellence methodology) implementation within the Enrollment Operations teams reducing waste, and increasing efficiency by over 50% in the first year.

Naperville, Illinois

Operations lead for Enrollment Reconciliation. Streamlined Reconciliation Extract and implemented QA process to ensure files pass statistical validations. Operational lead on a cross-functional team for management of the 2016 renewal process winning a 5-Star award for my contributions to the program. Operationalized Automated Controls resolving yellow diamond audit finding in 2015. Led back-office teams responsible for enrollment and membership processing operations. • Led development of multiple tools to aid enrollment and membership processing resulting in distributed processing power and automation which improved cycle times exponentially.

Naperville, Illinois

Partner with Marketing and Sales to advance goals and promote increased automation with enrollment for major medical, temporary, and Medicare supplement insurance plans. Primary operations liaison for private exchange and other integration partners. Project lead for PCI Remediation project for eBroker integration partners.

Supervise the specialist teams in a full-service contact center. Manage back-office inventory for benefits and membership processing transactions. Lead recruiting efforts for Member Services. Actively participate in projects and workgroups involving process improvements and new technology including first call resolution and automatic claims re-adjudication. Liaison and primary point of contact for overflow vendors in multiple locations. Developed Access databases to improve reporting and exception handling for the department.

Business Readiness lead during the transition of the business to a new office with new systems and applications. Accountable for back-office functions including application processing, membership processing, and benefit written inquiry areas. Developed and approved operations processes and procedures. The Business transition included recruiting new staff and developing a contingency plan for all aspects of the process.

Naperville, Il

Oversight for the Benefit Administration unit for BCBS plans in four states. Ensure compliance with state and federal mandates and efficient administrative procedures. Responsibilities of the unit include claim processing and risk management activities. Supported a team of five supervisors and their direct reports. Led procedure and process review during ACA implementations. Eliminated the paper claim file and transitioned to a paperless process.

Supervise a team of claim examiners with responsibility for benefit administration in IL & NM. Responsibilities of the unit include claim processing and risk management investigations. Led an effort to implement the Paperless Inventory application and designed workflows in the department. Designed and implemented an investigation audit process.

Advanced from Junior Examiner to Senior Examiner in this timeframe. Responsible for risk management activities and claim processing.

Bachelor Of Business Administration - Bba, Business Administration And Management, General

Education record