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benefits administrator hris resume example with 18+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary
Energetic Benefit/HRIS Administrator who is self-motivated and result driven with strong communication, analytical problem solving and reasoning skills. Extensive background and knowledge in employee, group and individual benefits.
Experience
Benefits Administrator/HRIS, 02/2015 - Current
The University Of Oklahoma Norman, OK,
  • Administer all aspects of benefit administration for the company's group benefit and voluntary benefit programs.
  • Manage open enrollments, New Hire Enrollments and benefit training; COBRA, terminations, providing support for accidental death and dismemberment claims.
  • Manage of the 401k rollovers, distributions, loans, hardships and compliance testing, while working directly with benefits broker, 401k Plan broker and adviser along with all additional third-party administrators.
  • Responsible for managing and executing the day-to-day operations of the group benefit programs.
  • Investigate new benefit programs, improve existing programs, supervise and monitor benefits administration, design employee benefit plans and provide analytical and technical support in the delivery of the benefits programs.
  • Responsible for the maintenance and accuracy of the HRIS system.
  • Handle benefit inquiries and complaints to ensure quick, equitable, courteous resolution while providing excellent customer service and quality.
  • Manage Leave of Absences (LOA) and workman compensation process 
  • Coordinate payment plans and/or arrears for employees in the event on a leave of absence.
  • Develop long term objectives regarding benefit programs in conjunction with the human resources team.
  • Analyze current benefits, evaluating the use, service, coverage and effectiveness in conjunction with cost and competitive trends.
  • Work directly with other departments such as Payroll, IT, Finance, and Executive Leadership to assist with projects and to provide monthly or weekly data as needed.
  • Administration task include but not limited to completion of State Disability Insurance (SDI) claim forms, State EDD unemployment claims, completion of workers compensation claim and interviews.
Senior Case Manager, 08/2007 - 08/2014
Pacificsource Billings, MT,
  • Effectively managed grievance, appeal, and external review process, ensuring all relevant information was collected and assessed to establish and communicate appropriate decisions.
  • Researched issues using federal and state law and regulations, relevant contract law and other sources as defined by the client contract.
  • Determined whether cases required review by independent physician consultants.
  • Scrupulously collected and ensured that all data gathered for case files were accurate.
  • Responded to customer service calls for Medi-Cal, Commercial Group, Individual Health Plans, Covered California including Non-member enrollees, representatives, providers, and internal health plan contacts.
  • Prepared case file for investigation and presentation of highly time sensitive member grievance cases and presented to Committee for decision.
  • Upheld strict company and legal regulation and compliance requirements.
  • Effectively communicated to members via phone and mailed correspondence, regarding the Health Plan's determination within regulatory timeframes while meeting quality and customer focused standards.
  • Adapted to a constantly evolving and high pressure environment.
Appeals and Grievance Coordinator, 05/2005 - 09/2007
Blue Shield Of California City, STATE,
  • Responsible for the Health Plan Appeals and Grievance preparation of case files with appropriate and relevant materials and determined outcome.
  • Responsible for decision making according to members Health Plan Benefits within the regulatory timeframes.
  • Providing excellent customer service and problem resolution for members, providers and internal business partners.
  • Assisting members in maneuvering through the complexity of the grievance process and responsible for ensuring compliance with multiple regulatory and accreditation requirements.
Member Services Representative - CalPERS Liason, 07/2002 - 05/2005
Blue Shield Of California City, STATE,
  • Provide customer service in the area of benefits and claim inquiries to physicians and subscribers while ensuring quality care by troubleshooting patient and provider issues.
  • Team correspondence representative, coordinating with team members to resolve issues with providers and subscribers within a thirty day time period.
  • Act as a team lead and assist Supervisor with projects; escalated supervisor calls and providing one-on-one training to team members for claim adjustments, telephone customer service and updating of case files for coordination of benefits.
  • Conducted single operation project acting as liaison and responsible for handling the State of California (CalPERS) correspondence and provide efficient response regarding their inquiries regarding benefits, claims, and authorizations.
Education and Training
: General Studies, Expected in 2003
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Sierra Community College - Rocklin, Ca
GPA:
Status -
Dental Assistant DA Certified: , Expected in 1999
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Sierra ROP - Placerville, CA
GPA:
Status -

Regional Occupational Program for Dental Assisting

High School Diploma: , Expected in 1999
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Oak Ridge High School - El Dorado Hills, CA
GPA:
Status -
Skills
Microsoft Office (Word, Excel, Access, PowerPoint, Outlook)Health Connect (Automated Medical Records/Billing System); EPIC; Customer Integrated Workflows Reporting System (CIWRS); Mainframe; Lotus NotesTyping 60+ WPM; Bookkeeping; Face to Face Consultations; appointment schedulingCommunication and interpersonal skills; solid analytical skills; problem solving; critical thinking; excellent oral & written communication and excellent customer service skills.Knowledge with ICD-9, HCPC, CPT, and able to read and understand Evidence of Coverage (EOC) booklets and Explanation of Benefits (EOB).Vast knowledge of HIPPA, Knox-Kneene, Department of Managed Health Care (DMHC); Department of Insurance (DOI) and National Committee of Quality Assurance (NCQA) regulations and guidelines as well as Federal and Medi-Cal policies and procedures.Skilled with Leave of Absence (LOA), Workers Compensation, California Family Rights Act (CFRA), Pregnancy Disability Leave (PDL).Implementing and enforcing policy and procedures.Team player who is able to work under pressure, independently and in group settings. 

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Resume Overview

School Attended

  • Sierra Community College
  • Sierra ROP
  • Oak Ridge High School

Job Titles Held:

  • Benefits Administrator/HRIS
  • Senior Case Manager
  • Appeals and Grievance Coordinator
  • Member Services Representative - CalPERS Liason

Degrees

  • Dental Assistant DA Certified
  • High School Diploma

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