Jennifer Daniher Email & Phone Number

Lansing, Michigan, United States

East Lansing, Michigan

Southfield, Michigan

East Lansing, MI

• Provide day-to-day oversight of multiple departments, including Claims, Enrollment, and Underwriting with staff of up to 6.
• Perform ongoing audits and monitor Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) for correct claims processing and reimbursement. Communicate errors and collaborate with TPAs and PBMs to.
• Review and interpret state documentation related to program benefits and claims submission. Advise staff of policy changes and billing issues.
• Develop and maintain financial operations documentation, including policies, procedures, and process workflows.
• Work with outside vendors to ensure quality administration of individual and group health plans; including enrollment of members, claims payment, generating premium invoices, and benefit changes.
• Reconcile Individual member Advance Premium Tax Credit (APTC), Cost Share Reduction (CSR), and premium payments.

• Managed three departments: Membership, Sales Support, and Stock Room. Included all hiring, annual reviews, corrective action, and daily work flow between departments.
• Maintained enrollment and eligibility information for over 150,000 members in several different lines of business: Medicaid, Commercial (HMO/POS), and Self-Funded.
• Participated in multiple sub committees, especially those geared toward interpreting, communicating, and implementing Health Reform guidelines for members and groups.
• Supervised the implementation of at least 50 new processes and procedures to ensure membership and sales support activities were effective, efficient, and capable of handling membership growth.
• Administered TPA functions for McLaren Health Plan’s COBRA, Flexible Spending Account, and Dependent Care Account services.
• Worked closely with commercial sales team and led all quoting activities in the Sales Support Department to increase commercial membership at the health plan.

• Manager of Insurance Operations (1999 - 2010)
• Managed the daily operations of the third-party insurance administration department for Automobile Dealers Accessory Corporation, a subsidiary of MADA.
• Supervised a team of 6 employees.
• Allocated and forwarded monthly over $7M of insurance premium to appropriate carriers. Reconciled member accounts, oversaw processing of all member changes in Blue Cross Blue Shield of MI, Blue Care Network systems.
• Administered COBRA services program offered to participating dealer members, which included sending all notifications to potential COBRA subscribers, processing all member changes and reinstatements, customer service.
• Maintained COBRA certification Account Service Specialist (1996 – 1998)

Education record

High School