Sonia Colón Email and Phone Number

* Managed the marketing proposal process, starting with request for proposal (RFP) to final proposal(s)/cost analysis delivered to Sales Person/Account Managers.* Work with Sales team in the strategy for key opportunities, gather group and census information.* Work with Account Managers in the strategy for the renewal process for current clients.* Run quotes in different online quoting systems and prepare cost analysis with plans/benefits and rate recommendations.* Manage/track quote responses from carriers.* Managerial/Administrative duties such as coaching, distribution and monitoring of workload, among others.*Managed a remote team of analysts.

Research and investigate claim issues for EPIC's employer groups and their employees to include Medical, Dental, Vision, Short-Term and Long-Term Disability, Group Life, COBRA, Stop Loss (Reinsurance) and Flexible Spending. Analyze claim payments and policy contract language to investigate complaints, resolve issues, file appeals and communicate resolutions. The Specialist partners with Benefit Account Managers, Producers, and other internal business units to provide high-quality customer service to client companies on a daily basis which includes communicating with carriers, providers, employers and employees regarding coverage, claims, compliance, enrollment, eligibility and sometimes billing issues.Translate Benefit Guides, Enrollment Forms, and other Open Enrollment documents from English to Spanish.

Responsible for the oversight of the claims production daily operation in order to assure the accurate and timely payment of providers claims and member reimbursement according to state, federal laws and regulations. Responsible for the monitoring and accomplishment of department projects.Identify and report trends, findings and any deviation in the claims payment processes.Responsible of creating, reviewing and updating policies and procedures established in the Production area.

Responsible to supervise the Quality Review area as well as Claims Department training program. Monitor and improve overall quality results within the Claims, Business Configuration Unit and Provider Network Operations Departments in order to accomplish standards for Payment, Financial and Processing Accuracy established by the organization. Responsible for the supervision of Quality Review Specialists and Trainer. Overall oversight of daily compliance of performing quality on samples identified. Responsible of creating, reviewing and updating policies and procedures established in the Claims Department.Identification of error trends, root cause analysis, as well as recommending action plans to improve individual and department quality results.

Responsible for keeping Business Owners abreast of project activities. Work hand in hand with the Program and Project Managers taking an active role in decision making, issue resolution and deliverable reviews. Performed administrative duties in conjunction with the management of the business resources assigned to the ACT V Program (Time Keeping, vacations, personal time, leaves, performance reviews, salary, incentives, among others).Provide coaching and mentoring Facilitate communications at the executive levelAssist business resources with problem resolutionsEnsured that business needs and expectations are met throughout the project, promoting industry’s best practices and standardsPromoted project and maintains strategic relationships and communication channels throughout the business organization

Assist and support the Department’s Vice President and Business Operations Improvement (BOI) Team in the planning, organization and implementation of the projects managed by them.- Manage the pending lists of assigned projects/tasks, following-up and escalating as needed.- Maintain an appropriate relationship with internal customers and ensure that the project results are comprehensible to management.- Receive and compile progress reports from BOI Project Team Members on their assigned tasks/projects and refer/report to the Head of BOI.- Support senior team members by scheduling and planning meetings, creating agendas, documenting minutes, distributing project material and following up on action items as required.- Produce assigned departmental purchase orders, obtaining authorization for purchases and maintaining records.- Assist/coordinate in the processing of invoices as requested.- Track budget requests/transfers and expenses.- Manage the VP’s calendar/schedule, flagging potential conflicts and solving conflicts.- Manage the departmental vacation plan based on the company’s and department policies.- Maintaining project documentation on Share Point.

In charge of the Grievances & Appeals, Quality Audit and Operations Training departments.• Ensure compliance with regulatory requirements (CMS, ASES, DOI) within Grievances and Appeals processes.• Responsible of the Quality Assurance process for the Call Center, Claims, Benefits and Enrollment departments.• Partner with Operational Leaders to develop documentation for business operations requirements across all areas.• Act as a liaison between operational and functional areas, to identify and address barriers cross-functionally.• Design and manage the execution of departmental plans and objectives to ensure efficient and effective business processes. • In charge of strategic planning, budgeting, business improvement and development of staff. • Provide coaching and feedback to enhance the contribution, competencies and performance of associates.

Responsible for implementing 2 to 4 projects per year that address customer satisfaction, produce bottom-line improvement and reduce defects. • Train, encourage and support Green Belt projects by participating and implementing recommended improvement actions. Ensure key training and certification metrics are obtained.• Assist in deploying 6-Sigma initiatives as the primary means of delivering customer-driven improvement efforts and reducing costs.