Nicole Downs Email & Phone Number

Syracuse, Ny, Us

Rochester, New York, Us

Daytona Beach, Florida, Us

Participate in client meetings/sales calls with brokers, employee enrollment meetings and all departmental service meetings. Responsible for the servicing of selected Group Agency Accounts. Functions include but not limited to reconciliation of claim issues, benefit inquiries, enrollment issues, and carrier premium billing discrepancies. Intake and audit control of enrollment information.Track inquiries and complaints regarding carrier claim resolutions.Correspond with carriers, members and providers to educate, clarify benefits, resolve claims, verify eligibility and resolve disputes. Investigate, research and provide timely responses to all service issues.Assist with implementation of new business.Routinely educate on current or pending Federal and State legislation with regard to HIPAA, COBRA laws, FMLA and any other legal issues as they pertain to Employee Benefits.

Liverpool, New York, Us

Us

Generate leads and enroll beneficiaries into the United Healthcare Nursing Home Medicare Advantage plan through appropriate use of face to face, telephonic or other enrollment strategies  Develop and manage account specific strategies to educate and engage facility personnel, resulting in the generation of interested residents and/or families (responsible parties)  Utilize traditional account management strategies to uncover needs of the facility  Document all activity to ensure compliance with Medicare Marketing Guidelines  Develop and maintain relationship with facility staff through ongoing communication, education and demonstration of the value proposition  Hold weekly or monthly meetings with facility staff to introduce features and benefits of the plan, review growth, identify obstacles and create solutions Implement role specific processes designed give facility personal the ability to educate beneficiaries and generate interest in each assigned facility  Participate in internal events at each assigned Skilled Nursing Facility  Present sales and growth information at quarterly Business Review Meetings at each assigned facility  Comply with all CMS, organization and departmental regulations and policies  Provide market leadership with facility feedback relative to service and product acceptance

Us

Guides Community Outreach team with day to day successes and obstacles Train new employees and coaches current employees who are not meeting goal  Provide potential marketing opportunities to community outreach and sales teams  Ensure individual ROI for marketing strategies is sustainable  Establish new/maintain relationships with community partners, providers, clinics  Collaborate with community partners to ensure participation in community events  Collaborate with Sales Agents and Agent Managers to understand needs of the team  Identify opportunity and develop a marketing strategy, in a diverse multi-cultural population  Create educational and sales events within target population  Execute, plan and coordinate resources with vendors, partners, sales agents, etc., to ensure a successful event  Maintain New York State Accident & Health Agents License  Maintain up to date knowledge of MEDICARE & Medicaid

Us

Make prudent decisions that are timely, well researched, and reflect awareness of impact as well as ability and willingness to provide support and reasoning for decisions  Respond to each appeal/grievance, Department of Financial Services and Attorney General complaints with the appropriate letter needed  Uses strong research and problem solving skills to determine issues with claims and identify claim errors or trends  Meets deadlines and goals set by the supervisor for projects and weekly production  Coach team on how to operate new systems, problem solving, and questions on work  CRM program super user, maintain up to date knowledge of system and answer any questions from other team members Audit master letter templates for inaccuracies, benefits, and grammar  Maintains New York State Accident & Health Adjusters License

Handle benefit questions related to Health, Dental, and Vision for eligible members of the City of SyracuseDetermine eligibility for benefits and enrolls employees in the health insurance program  Determine amount of premium shares to be collected and creates payment plans for members  Handle benefit issues with insurance companies, providers, and other agencies  Notify members who recently turned 65 years of age of the coverage entitled to them and assist with Medicare questions  Assist members with forms, ensuring all necessary information is present before authorization  Assist in annual open enrollment presentations and paperwork  Create letters to members on various situations using mail merge  Notify members of coverage and premiums while out on Workers Compensation, FMLA, Leave without pay, and Military Leave  Ensure accurate payroll and pension deductions through Microsoft Excel  Assist with annual audits  Maintain payments and deposit spreadsheets through Microsoft Excel  Compute monthly bills, reimbursement vouchers, and workers compensation notices through Microsoft Excel