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Objective A position that will allow me to use my extensive benefits background in a human resources environment.
· Experience in Health & Welfare benefit programs (PPO,POS,HMO & self-insured plans)
· Knowledgeable of both Federal and State Employment Laws
· Presentations at Benefit Fairs
· Expert resolution of claim and policy discrepancies with vendors and employees
Accreditations & Education
2005 Enrolled in the B.S. Business Administration – Human Resource Management Emphasis,
2005 SHRM HR Generalist Certificate Program,
2004 Human Resource Certificate Program,
2001 Washington State Life & Disability Agent’s License (expiration 12/07)
2000 HIAA, Managed Healthcare Professional designation (MHP)
January 2005 – Present Life and Health Customer Service Agent/Human Resource Generalist
The Customer Service Agent (CSR) for the alphabetical split of M-Z. Responsible for the general customer service to the group administrators as well as assisting with administrative issues, claims questions and/or issues, and general customer service to group administrators. Sell individual medical, life and dental policies to the individual market place. Act as consultant to key employees and brokers on all benefit issues. Analyze and research details of benefit plans and contracts, COBRA administration, administration of medical insurance (including PPO, POS, HMO, and Self-Insured Plans). Negotiate and resolve claim and policy discrepancies between insurance carriers and health providers.
Create the benefits to be posted on our internal intranet, ongoing revision of the employee manual and answering any other questions related to our company benefits.
September 2004 – January 2005 Customer Service Representative - Retail Clerks Welfare Trust
Responsible for providing health claims customer service to participants, union locals and providers regarding eligibility, benefits and claim status. Provided telephone customer service support by responding to and documenting telephone and written inquiries. Set up claims to be re-opened; process check tracers, stop payments, and claim audits.
BenefitPort Northwest (formerly The Reppond Company),
July 2003 – May 2004 Account Coordinator (Small Group)
July 2002 – July 2003 Account Coordinator (Large Group)
The Account Coordinator is responsible for the general day to day servicing of groups, which included assisting with administrative issues, claims questions and/or issues, and general customer service to group administrators. Preparation of renewal notifications and timely distribution. Provided group status information to sales management. Where Large Group uses Benefits Specialists, the Small Group position required both account coordination and direct customer service.
September 2000 – June 2002 Benefits Specialist
Served as an expert benefits consultant coordinating employee benefit eligibility transactions, administering the health and welfare benefit programs for employer groups with 50+ employees. Benefits Coordinator for four marketing teams. Consultant to key employees and executives regarding all benefit issues. Analyzed and researched details of benefit plans and contracts, COBRA Administration, administration of medical insurance (including PPO, POS, HMO, and Self-Insured Plans). Negotiated and resolved claim and policy discrepancies between insurance carriers and health providers. Advised and consulted with clients and their employees at Open Enrollments presentations and Benefit Fairs.
July 1998 – July 2000 Account Associate, PacifiCare of
Duties included service and renewal activities in support of increasing and retaining membership by providing support to sales and service staff using standard policies, procedures and guidelines. Scheduled periodic service calls with employer groups to include group presentations, question and answer sessions and present PacifiCare products at open enrollment meetings. Assisted sales and service staff in contract renewals, upsales and new sales. Gathered census information and prepare renewal rate proposal letters.
QualMed Health Plan,
October 1996 – July 1998 Assistant Underwriter
Duties included preparing and completing small group renewals and quotes, performing large group renewals using ACR rating methodology, negotiating and strategizing final renewal rates and completing work-ups on large renewals and quotes for Underwriter I and II. Provided sales with requested alternate benefit design costs and experience reports. Knowledgeable of small and large group legislation for
May 1995 – October 1996 Lead Member Service Representative
Sept. 1994 - May 1995 Government Accounts Coordinator
Nov. 1991 - Aug. 1994 Member Services Representative
1986 – 1991 Billing Clerk and In-House Collection Agent, Armstrong Ambulance Service,
1983 – 1986 Medical Secretary and Ophthalmic Assistant,
1973 – 1983