I am responsible for supporting numerous Key Accounts which are geographically located throughout the United States with education on Aetna's electronic tools via our secure provider website. In addition to this I support several Key Initiatives such as Precertification Submission Utilization and Call Redirection. I participate in several projects throughtout the year as a subject matter expert.

I was responsible for supporting the state of NJ and CT with regard to determing root cause and resolution of all Aetna supported electronic transactions via our secure provider website providing technical support to my clients through education. I processed ERA and EFT changes, terminations and enrollments. I lead our Decentralization project to a successful completion.I also supported incomming electronic provider inquiries.

. Responsible for training new hire CSR's in regard to benefits, eligibility and claims in a classroom setting. . Train multiple main frame applications as well as web based applications to new employees.. Conduct refresher training for existing CSR's in a classroom setting as well as via iLinc. . Conduct side-by-side CSR evaluations and deliver feedback. . Facilitate mentoring sessions with CSR's who are not meeting minimum performance metrics. . Enforce HR policies such as Attendance, Code of Conduct and Disciplinary Guidelines. . Assist management team with creating, delivering and tracking Process Improvement Action Plans.. Provide oral and written one-on-one bi-weekly feedback to new hire trainees. . Take part in focus group meetings as well as special projects. . Monitor phone stats such as AHT, ACW, AUX, and Hold Time via CMS & RTA. . Develop and maintain collaborative relationships with internal and external constituents. Act as a liaison between other areas, including management within various segments.. 6 years of Project Management experience.. Completed the Six Sigma Yellow Belt Process Improvement certification program.. Conduct new hire interviews.. 4 years volunteer experience facilitating Open Enrollment meetings for National Accounts . 2 years volunteer experience facilitating Open Enrollment meetings for P&L and Federal . Assist Curriculum Developers & Instructional Designers with storyboarding.

. Provide resolution with regard to In-bound member and provider inquiries related to benefits, eligibility and Claim inquiries. . Resolve correspondence inquiries via ECHS and fax. . Assist supervisor with special projects. . Mentor newly hired CSR's.

Process group medical claims; investigate cosmetic surgery and pre-existing condition claims.

. Complete and maintain quarterly comparison reports. . Make additions, deletions and changes to plan sponsor contract. . Print and send monthly billing statements to company. . Post monthly premium payments to plan sponsor account. . Maintain written correspondence using WordPerfect 5.0. . Act as a liaison between plan sponsor and insurance company.