Dynamic and motivated professional with over 12 years of experience in generating and building client-centered relationships, executing projects from concept to completion, and driving strategic decisions through effective leadership. Skilled in identifying technical malfunctions, and removing impediment resolutions for clientele/company by meeting their needs. Proven ability to gather and organize data effectively while maintaining confidentiality and displaying professionalism in all situations. Consistently recognized for technical troubleshooting skills used to rapidly and cost-effectively resolve challenging technical issues. Recognized regionally for improving Residential property from worst performing to number in the entire property profile Highly motivated manager with proven proficiencies in time management, staff training, conflict resolution, and mentoring while instilling motivation and promoting teamwork.
Skills
Compensation and Benefits
Customer Inquiries
Technological Knowledge
Customer Service Process Improvement
Benefits Explanations
Requirements Analysis
Government Rules and Regulations
Directing Team Members
Account and Ledger Reconciliations
Administration and Reporting
Project Team Coordination
Business Intelligence Data Modeling
Best Practices and Tools
Stakeholder Negotiations
Communication Planning
Scrum Methodology
Change Management Process
Project Management
HTML5/CSS3/JavaScript/
SQL/Python
Excel Analytics
PeopleSoft
Jira/ZenDesk/Service Now
Microsoft Applications
Epic/Prelude/Mychart
AWS
Work History
04/2015 to 01/2022
CONSUMER BENEFITS SPECIALISTTransunion – Cherry Hill, NJ,
Assist consumers in applying for or obtaining enrollment into the following programs;
Medicaid, Medicare, SSI, SSDI, RSDI, CHIP Other federal, state, and supplemental programs
Responsible for completing and maintaining internal client financial records and ensuring
timely submission to the Finance Department
Collect and compile supportive medical evidence, required documents, and application
forms to properly build
Coordinate and conduct application appointments
Provides technical assistance to consumers around accessing benefits
Jessica Claire (555) 432-1000
Advocate in appealing denied benefits, including court appeals
Coordinated meetings between assigned case managers and consulting clinical staff to help
resolve claim issues
Facilitated training to clinical staff in a group setting regarding state and Federal policies for
Benefits
Respond to and Resolve Benefits inquiries for Annual Medicare Enrollment
Managed the entire eligibility process in the database and communicated updates within a
timely manner to clients
07/2012 to 04/2015
COMMUNITY ASSISTANCE MANAGERNeighborhood Healthcare – Escondido, CA,
Coach, mentor, and train team across broad technical, financial, and business disciplines
Focused teams on business objectives and tracked progress to ensure project milestones
were completed on time, on budget, and with the desired results
Built positive relationships with prospective and current tenants as well as answered
relevant questions about the property and amenities
Prioritized timeliness and successful completion of maintenance requests
Prepared and executed detailed and legally compliant lease agreements
Delegated all financial procedures including verifying renter income, processing monthly
payments, and executing default protocols
Establish a learning organizational system to support accurate record keeping, efficient
financial transactions, and prompt renter complaint resolution
Developed a database management program, leading the team in meeting all project
deadlines.
08/2010 to 07/2012
ADVISORHealth And Human Services, TEXAS WORKS – City, STATE,
Analyzed and interpreted departmental, utilization, financial, and operations data for
decision-making for out-of-network and in-network providers’ post-service/pre-service
Communicated verbally with the members, providers, or authorized representatives during
the research process to further the member's complaint during the review of each
case-by-case scenario
Identify discrepancies between files and suggest program improvements by way of
methods to avoid discrepancies
Review remittance advice for denials and trends for the payers assigned
Referring all-payer
issues/problems to Leadership in a timely manner, making recommendations to the Project
Manager for resolution and elimination of denials where possible.
11/2009 to 03/2010
CLINICAL PHARMACY TECHNICIANFirst Health Services – City, STATE,
Evaluated and authorized prior authorization claims requests made by physicians
Jessica Claire (555) 432-1000
Provided support to customers/physicians in benefits administration, provider network
development and management, and financial services
Researched and resolved physician or patient inquires and grievances verbally/written
results
Troubleshoot pharmacy claims, formularies and pharmacy overides
Analyze therapeutic orders from physicians and submit to Charge Pharmacist if needed
Assisted Pharmacies and Physician obtaining patient records in Accordance of the Health
Insurance Portability and Accountability Act
Distilled direct member reimbursement requests and submit Pharmacy Benefit
Administrator for payments release
Anticipate customer needs and proactively identify new solutions to problems
Interfaced with customers via telephone at high volumes.
Education
Expected in 05/2009 to to
Bachelors of Science: Interdisciplinary Studies University of Houston-Downtown - Houston, TX GPA:
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