Supervisory - Assume director and manager level responsibilities in support of business migration and downsizing, including documentation, training, quality control, issue resolution management, large scale project management, build management, and specialized benefit setup (network, copayment, clinical, exclusions). Quickly assimilated information to become “go to” person for Benefit Fulfillment Group. Team exceed build triage, quality, and quality control goals. Develop staffing plans to support ongoing personnel reductions. Co-manage offshore team; ensured build timelines and quality goals were met. Manage team skillfully and competently. Encourage team members to pursue internal and external professional development opportunities and expand knowledge of their roles and company. Promote individual participation, communication, and feedback.Migration Management - Evaluate and update processes to ensure coverage through migration stages and downsizing. Lead initiative for online record retention and created framework for hard copy document retention.Cross Functional Support - Serve as division’s subject matter expert for ongoing questions about benefit setup. Partner with other functional areas in division and company to provide training, resolve issues, and answer questions related to build process. Manage implementation of regulatory requirements to include public sector call set up, synchronization of request system to database setup, documentation and training, and issue resolution management. Manage escalations of priority requests.Information Management - Managed daily and monthly reporting to internal partners and client. Co-author specialized training documentation for retro request processing handled outside of eligibility files. Create and maintain SharePoint to provide documentation access to team, division, and outside functional areas. Manage ad hoc requests to supply information, generate reports, make corrections, update systems, etc.

Developed and maintained Standard Operating Procedure / Quick Reference Guide. Performedd ongoing training for Benefit Fulfillment Group teams regarding new products and capabilities. Coordinated with QC team on tool updates and documentation of processes.Coordinated with multiple internal and external stakeholders at all organizational levels to capture operational requirements and answer ongoing questions. Worked with several teams simultaneously to gather, document, and execute requirements. Served as regulatory subject matter expert and owner of operational regulatory reference document. Represented Benefit Fulfillment Group on cross functional teams.Served as co-manager of initiative to populate client system with information from vendor system. Hired, trained, and managed team of temporary employees to research and populate system with accurate data. Answered team, division, and client questions regarding set up and direction for project. Coordinated, assigned, and monitored workflow to project completion for all team members. Ensured smooth process and timely completion of project.Identified, researched, and performed system updates to resolve global issues for claim adjudication. Served as documentation and training liaison for issue resolution in build process. Served as a resource for other areas within the division regarding Benefit Fulfillment Group capabilities and related inquiries. Assisted other teams within division as needed.

Assisted in coordinating services and vendors for merger between Horizon Agency and RAM Benefits. Served as primary liaison for plan administrators and vendors regarding Health, Life, Dental, FSA, 401(k), and Pharmacy Benefit Managers. Concentration on group and individual coverage offerings, managing coverage, vendor changes, eligibility, quoting, and organizing. Served as outsourced HR, assisting with eligibility, COBRA, HIPAA, and other federal and state notifications. Processed and negotiated renewals, market clients, analyze quotes and deliver results to client. Concentration on new client implementation and set up, benefit coordination, and pricing to meet client and vendor needs. Served as EDI administrator, overseeing transmissions with carrier and vendors, assisting in testing and auditing files, and facilitated FTP transmissions between systems. Created Employee Benefit Centers and Touchpoints portals for prospective and current clients. Managed and trained, internally and externally on operating systems, including the agency management system.Reviewed existing plans and contracts to determine suitability for client, including stoploss, wellness, and pharmacy benefits. Coordinated between carriers on termination and implementation of new products, along with carryover and reporting. Assisted clients with benefit, claims, and HR related questions and concerns.

Served as primary liaison for plan administrators and vendors regarding Health, Life, Dental, FSA, 401(k), and SERP plans. Concentrating on large national accounts as well as small and individual coverage offerings, managing coverage, vendor changes, eligibility, and quoting. Served as outsourced HR, assisting with eligibility, COBRA, HIPAA, and other notifications. Processed renewals, market clients, analyze quotes for delivery to client. Served as EDI administrator, overseeing transmissions with carrier and vendors, assisted in testing and auditing files, and facilitate FTP transmissions between systems. Created Employee Benefit Centers for prospective and current clients, which include logo branding, benefits, eligibility, and plan summary information. Managed our company website, and our internal group benefit manager system.Volunteered to assist with HR functions including tracking and recording time off for employees, mentor employees regarding personnel issues, training new and existing employees, analyze business needs to determine future system and training requirements, and served as office manager.

Served as primary liaison for brokers and plan administrators regarding Health, Life, Dental, and 401(k) plans with focus on proactive measures to improve overall plan experience.Increased overall plan persistency and client retention by using project management and expedited problem resolution skills for 52 clients.Facilitated annual enrollment and mid-year informational meetings for members and Human Resource professionals, including training on plan and web site demonstrations in order to ensure understanding plan administration and member satisfaction.Completed, submitted, and followed through on all new case submissions. Drafted documents to summarize benefits under the plans.

Monitored implementations, acquisitions and divestitures, and maintain services on terminations. Served as primary client contact and partnered with all departments to ensure prompt and satisfying service to client.Analyzed and interpreted client reports. Designed, proofread, and distributed member ID cards. Investigated and resolved billing issue errors.Consulted with client to streamline, improve, or update plan. Interacted with all company departments to improve services to client. Frequently called upon to resolve technical systems information for the claims payment systems.

Responsible for 16 corporate accounts, including implementation, plan interpretation, set up, loading, and payment. Served as direct contact with clients. Provided immediate resolution of payment inaccuracies.Served as interim supervisor during transition between supervisors.Assigned tasks and directed workflow of 20 claims processors. Monitored workflow, production, and accuracy of each examiner while managing and motivating each team member.Implemented plan specifications audited system for payment levels, served as contact with plan loader to verify accuracy, served as member of committee to evaluate production standards, participated as member of committee to load paper plan documents on-line for intra-net, and served as member of Policy and Procedure Committee that authored department procedures for workflow, training, and claims payment.Developed auditing standards, verified accuracy of claim payment, and followed up with staff regarding auditing guidelines.Trained new and existing employees on claims payment system, group summary plan training, and provided follow-up training.Created and standardized processing procedures for End Stage Renal Disease (ESRD) claims, resulting in reducing overpayments and improved claims processing.

Responsible for accurate and timely claims payment for Health Risk Management in-house employee health plan, employee appeals, and assigned groups.Served as main resource for claims examiners, supervisors, and customer service representatives in absence of technical specialist.Audited the system for new plan coordination, implementation and trouble-shooting for new health plans, and trained examiners on claims processing procedures.