Zayra Garduno Email & Phone Number

Rancho Cordova, California, United States

Los Angeles Metropolitan Area

• Supports Consultant or Senior Lead Service on assigned accounts (combination of fully and self-insure) ranging between 100 to 1,000 live group.
• Act as a liaison between the client, carrier, and service team for any eligibility, billing, claim issues, and assist with enrollment audits and/or discrepancy reports.
• Assist clients implementing new carriers or vendors.
• Develops financial models and reports for Client and more senior staff, provides interpretation and implication of analysis, as well as recommendations
• Conducts, creates, and interprets benefit benchmarking studies, design plan comparison reports, and Client marketing materials.
• Participates in negotiations with carriers for new and renewal quotes

Aliso Viejo, California, United States

Aliso Viejo, California, United States

• Managing 14-17 clients (combination of fully and self-insure) ranging between 100 to 3,000 live group with a total revenue of 3.1 million dollars.
• Act as a liaison between the client, carrier, and service team for any eligibility, billing, claim issues, and assist with enrollment audits and/or discrepancy reports.
• Assist clients with implementations such as adding/changing benefit admin system, new carriers, building & testing applications and assist with EDI files/discrepancies.
• Assist with RFP/marketing process, OE communications, 5500 filling, wrap documents, and other compliance documents as needed.
• Coordinate and conduct OE/health fair meetings.
• Manage internal bench marking database.

Irvine, California, United States

• Overall responsibility to support the Account Manager by assisting in the day to day functions needed related to Supplemental Health products (Accidental Injury, Critical Illness, Hospital Care) for all market segments.
• Support Account Manager and Sales team in achieving their new sales and retention goals for profitability and growth.
• Leverage internal resources and use independent judgement and discretion to resolve complex client inquiries and solve non-routine problems, which ensure client satisfaction with products and services.
• Partner with Account Manager to support the preparation of client materials to educate, train and inform on benefits, services, and self-administration tools for billing and reporting.

• Managing 16 clients (combination of fully and self-insure) ranging between 100 to 3,000 live group with a total revenue of 2.2 million dollars.
• Act as a liaison between the client, carrier, and service team for any eligibility, billing, claim issues, and assist with enrollment audits and/or discrepancy reports.
• Assist clients with implementations such as adding/changing benefit admin system, new carriers, building & testing applications and assist with EDI files/discrepancies.
• Assist with RFP/marketing process, OE communications, 5500 filling, wrap documents, and other compliance documents as needed.
• Coordinate and conduct OE/health fair meetings.
• Manage internal bench marking database.

• Process insurance renewals and implement employer plan changes for small groups under 50 employees.
• Create and update census for marketing purposes.
• Request, review, coordinate updates and track client plan documentations such as benefit booklets, contracts, SBCs, and SPDs.
• Prepare and update open enrollment material for clients and attend meetings to answer benefit questions and distribute benefit materials.
• Update and maintain agency management and quoting system.
• Process enrollment changes, adds, and terminations based on contractual time frames.

Irvine, California

• Administer multi-state LOAs and FMLAs for an organization consisting of over 2,000 employees in 48 states. Processed 247 leave of absences in 2017.
• Assist Team Members with any disability (employer or state policy), eligibility, and benefit questions.
• Act as a liaison between the employee and HR, Payroll and management to coordinate pay while Team Members are collecting disability or state benefits, return to work process, accommodation request, and next steps when.
• Disseminate information regarding benefit status and outstanding claims as requested.
• Maintain professional relationships with contacts at insurance carriers and multiple benefit partners.
• Assist with projects(facilitate CPR training for cooperate office), coordinate open enrollment meetings, review workers’ compensation claims and provide monthly and quarterly reports to management as requested.

Orange County, California Area

• Responsible for reviewing, analyzing, and servicing new small group cases ranging from 1 to 100 lives.
• Underwrite new cases within specific deadlines to determine if applications are completed with all pertinent information and meet all internal guidelines.
• Send direct inquiries regarding missing documents and incomplete information to the general agency, broker, or internal sales department
• Maintain open communication and professional relationships with Brokers and Agencies to facilitate the receipt of all items required.
• Ensure that all data records are complete and accurate reflecting all required information.
• Educate Brokers and Agencies regarding product specific guidelines and requirements.

Irvine, California

• Responsible for reviewing, analyzing, and servicing new small group cases ranging from 1 to 50 lives.
• Send direct inquiries regarding missing documents and incomplete information to the group or internal sales department.
• Publish and disburse denial and withdrawal letters to the groups based on organizational policy and procedure.
• Process enrollment changes, adds, and terminations based on contractual time frames.
• Solve escalated billing discrepancies, request manual adjustments, and produce final group invoicing.
• Maintain professional relationships with contacts within the insurance carrier organizations and frequently send inquiries regarding employee eligibility.

Newport Beach, California

• Responsible for the monthly load, analysis, review, and processing of approximately 30 EDI files for senior and commercial plans for 4 IPAs and medical groups utilizing Eligibility Manager®.
• Identified and manually corrected critical discrepancies and issues within the load which could disrupt the overall EDI process.
• Consistently provided quality customer service to clients by answering a number of questions based on eligibility, copays, dual coverage, and COB utilizing Access Express.
• Produced new benefit mapping and EDI discrepancy reports as required for management review.
• Worked monthly issue reports as part of production for terminated members and open pending authorizations.
• Communicated with insurance carriers regarding EDI file issues and collaborated with Network Management regarding non-par physician disparity.

Irvine, California

• Responsible for managing eligibility, qualifying event changes, enrollments, terminations, and acquisitions for a large selfinsured national group with approximately 5,000 member lives and retirees.
• Maintained and managed a suite of products for the group that consisted of medical, dental, vision, flexible spending, life insurance, and voluntary products.
• Processed and finalized retiree medical payments and generated a number of weekly, monthly, and quarterly reports for executive management review.
• Participated in multiple strategic management sessions to improve operational performance for the department.
• Assisted colleagues within the organization with member questions, benefit information, payroll deductions, claims, and escalated issues during open enrollment meetings.
• Served as the Spanish speaking liaison for multiple open enrollment meetings for a number of groups.

Irvine, California

• Responsible for providing sales support to approximately 10 Account Executives within the Southern California, Arizona, and Nevada assigned territories.
• Performed initial review for all surgical and non-surgical orders received directly from the Account Executives and referring providers (hospitals, ancillaries, physicians, physician groups).
• Gathered pertinent information regarding the order including patient demographics, medical notes, documentation, prescriptions, and pre/post fitting instructions.
• Coordinated non-routine DME orders for custom knee braces, bone growth stimulation, and Continuous Passive Motion device (CPM) for knee arthroplasty / knee joint recovery for Worker’s Compensation, Medicare, Medi-Cal.
• Discussed benefits, deductible requirements, and copay responsibilities with patients and answered questions as needed.
• Obtained patient discharge dates from the Case Managers within the hospital or outpatient surgery center, scheduled the Continuous Passive Motion device (CPM), and ensured fitting within a 24 hour strict time frame.