Responsible for maintaining the client benefits website, documenting and executing benefits related processes, and offering support to the client, their participants and to the bswift service center. Performed ongoing audits and file reviews, ensuring data and results accuracy. Served as first level system support for each assigned client. Executed research and analysis to resolve participant cases.

Responsible for data entry based on employee online elections, life status change forms or benefit enrollment forms. Researched and corrected benefit enrollment issues and/or benefit carrier file discrepancies.• Responded to and/or contacted TriNet colleagues and customers as required to resolve health benefit related inquiries, issues, or escalations.• Maintained general benefit life event processing; monitored and corrected errors accordingly.• Ensured employee coverage changes were updated with benefit vendors in a timely manner.• Processed medical support orders, evidence of insurability reports, billing discrepancy reports, and/or ensured compliance with state specific benefit coverage regulations based on report output.• Answered questions regarding worksite employee benefits, TriNet plans and government regulations and processes.• Provided other administrative and data entry support in related departments including, but not limited to COBRA, Leave of Absence and Flexible Spending Account.• Worked cross-functionally with colleagues to deliver exceptional customer service and build cohesive interdepartmental relationships.

Served as a point of contact for clients.• Provided telephonic and email support to employees regarding enrollments and related questions through the Benefits Employee Engagement Center. • Established and maintained effective relationships with client’s benefit and HR managers.• Corresponded with benefit carriers to validate benefit coverage. • Responsible for creating and monitoring client interactions via CRM system.

Served as a point of contact for clients.• Provided telephonic and email support to employees regarding enrollments and related questions through the Benefits Employee Engagement Center. • Established and maintained effective relationships with client’s benefit and HR managers.• Corresponded with benefit carriers to validate benefit coverage. • Responsible for creating and monitoring client interactions via CRM system.

Supported Major Accounts Comprehensive Service clients from a practical, administrative and product perspective.• Secured, updated and confirmed appropriate information from enrollment-related internal and external sources (e.g., brokers, carrier account managers, client leadership, etc.) to support the configuration of the WFN/HRB application and associated integration/connections resulting in a successful annual enrollment event.• Managed activities within the project management tool related to the analysis and preparation for the enrollment process, including required system/profile/information gathering, requirements analysis, system updates, quality testing, data migration, and resulting deliverables. Provided WFN Benefits expertise.• Provided guidance and research in response to a wide variety of questions, requests, projects and issues presented by client HR/Benefits Administrators.• Generated reports and was responsible for monthly invoice reconciliation.• Built employee enrollment portals including plans and adding rates for client demonstrations.• Participated and in some instances took the lead on projects related to compliance, process improvement, standard operating procedures enhancements, technology rollouts and releases.• Worked closely with a client’s benefits provider(s) to resolve eligibility issues and to escalate service and/or claims issues on behalf of employees. • Acted as the primary point of contact for service teams and internal business partners regarding execution, governance and approval of various functions including but not limited to processing pending events, evidence of insurability, enrollment documentation adjudication, dependent verification, manual carrier updates, carrier connection management & error resolution, quality assurance & audits, reporting, data integrity audits, confirmation statements, and other transaction and batch processing.

 Responsible for reviewing, updating, managing eligibility data, responding to HR, billing and payroll inquiries, reviewing and responding to carrier file error reports.  Ensures services are being completed within the defined internal/external Service Level Agreement timelines.  Assures that documentation existed for all ongoing processes. Completes quality assurance testing of internal web applications.  Manages the full cycle COBRA process in accordance to Department of Labor requirements

Researches complex participant benefit issues and formulates resolutions/recommendations by analyzing fact patterns and applying plan provisions and best practices; Provides resolution in accordance with due dates and documents processes. Conducts system edit clean up including researching and determining reasons for errors and resolving errors which may include working directly with client. Manually performs benefit processes and complex calculations that are not automated, requiring plan knowledge, analysis, and interpretation.  Identifies and recommends a methodology for completing calculations by referencing guidelines and best practices and validates recommendation with Benefits Operations Manager for final approval. Works with the Benefits Operations Manager to recommend process improvements and coaching and training opportunities that were identified from participant issues, recurring edits, process delays, and quality problems. Created, monitored and managed network and helpdesk tickets to ensure issue resolution and customer satisfaction.

Responsible for administering assessment exams to new enrolleesGeneral library oriented duties (assign student bar codes, print ID cards, assist students finding reference material)Tutor new studentsParticipate in student enrichment services

Responsible for providing dedicated customer service for 2500 employees.Resolved enrollment and termination issues as well as dependent additionsActed as a liaison with insurance carrier to resolve claims issuesProvided assistance with the appeals processEnrolled and managed employees benefits via Benergy System.Answered calls relating to legislation and benefits laws regarding HIPAA, COBRA and FMLAUtilized internal software such as MS Outlook and other Microsoft applicationsMet all key contacts at least once to build solid relationships and met existing contacts as needed to further enhance relationshipsProactively call key contacts each month to check in and fact findMaintained a full book of business while continuing to provide A+ service I managed, investigated and resolved all employee and HR issues regarding claims, eligibility and benefitsAveraged 400 calls a monthMaintained a professional relationship with all the major insurance carriers. Backed up teammates whenever needed.Entertained employee questions during open enrollment meetingsFacilitated COB Responsible for employees’ problem resolutionMaintained employee files and records pertaining to benefit issues

Responsible for balancing accounts receivable Prepared bank depositsPosted patient paymentsMaintained medical charts Skilled at working appealsConducted all collections activity for the practicePerforms insurance investigations Responsible for medical electronic claims submission for two doctors in private practice. Radiology and diagnostic coding Generated monthly patient statements

 Responsible for proper administration and distribution of disability and unemployment benefits for Ford Motor Credit clients. Responsible for electronic and physical maintenance of data files for each participant. Reviewed claim forms, unemployment insurance certificates and check stubs to determine company liability. Responsible for adjudicating death claims

 Demonstrates thorough understanding of DRG reimbursement methodology and third party billing requirements. Extensive working knowledge of HCFA and UB92 claims reporting. Corrected and completed claim forms as needed, accessing information and translating data into information acceptable to claims processing system. Performed tasks related to supporting client’s claim and medical coding. Well versed in rules governing Medicare and Medicaid. Exhibited ability to “dig” into details for problem resolution or claims setup and maintenance

 Responsible for general correspondence, preparing and mailing application packets to potential clients. Scheduled and coordinated blood and lab exams. Ordered, tracked and followed up on all Attending Physicians Statements. Ordered lab exams and recorded/updated all activity in the activity log and database.

I processed, investigated, coordinated and adjudicated medical,dental, chiropractic, DME, psychiatric, orthopedic and skilled nursing claims. I was responsible for training new hires and providing them with all reference materials needed to perform their duties. I posted in patient and outpatient procedures. I was responsible for identifying errors in the system that would result in low processing numbers.

Complied data for claims reports and proposalsDetermined appropriateness of treatment according to terms of policyDemonstrated working knowledge of state regulations governing distribution of funds