Group Service Rep
CurrentResolving escalated benefit issues for all lines of large group business, including federal and NYS government contracts, as a direct liaison.Completing group benefit administrators’ inquiries by troubleshooting sensitive and escalated issues until satisfactorily resolved.Adjusting medical, hospital and dental claims; creating performance reports; reconciling and updating group eligibility files; corresponding with large and small group representatives.Performing as the key support resource in resolving all group claim and eligibility issues for all EmblemHealth lines of business, including meeting with administrators to strategize benefit structures and solutions.Furnishing support to account executives in relation to requests for proposals, required audit reporting, and providing direct administrative functionality. Interacting with health plan administrators and members in person at benefit fairs and group site visits to enhance subscriber group relations.Created processes for the implementation of Summary Benefit Comparisons, Requests for proposal, and NYS contracting language as required by the contract.Served as dedicated representative for Federal Office of Personnel Management’s high level service issues stemming from all lines of member interaction.