LEAD HEALTH PLAN BILINGUAL FINANCIAL SERVICES REPRESENTATIVE
Skype for Business
Lead Health Plan Bilingual Financial Services RepresentativeOct 2010 to Current Kaiser Permanente － Rockville, MD
Managed a team of customer service representatives or member services representatives.
Provides operational direction to team and resolves operational issues.
Implements line of business strategies.
Performs financial management, tracking, analysis and management of accounts receivables to ensure financial goals for the line of business are met.
Coordinates with processor(s) to ensure that clerical work on the account is performed in accordance with the group's requirements.
Identifies changes on eligibility reports.
Administration of group and individual member contract account balances.
Administer payment options for group and individual member contracts (to include credit cards, recurring credit cards).
Processes eligibility to include enrollment, changes to enrollment and member terminations.
Interacts with internal departments, internal staff, and external customers to resolve concerns and inquires in support of individual employer group contract administration.
Responsible for intake & resolution of complaint & grievance cases.
Responds & resolves all escalated issues ensuring first call resolution, responsible for timely intervention of service quality issues & the Department of Managed Health Care inquires/complaints, assists CSRs w/ complex problems & questions.
Accurately document results of assisting CSRs w/ complicated member issues & inquires.
Support training through delivery of specific modules & post-classroom training support, as needed.
Support User Acceptance Testing (UAT), to ensure successful role out & implementation of new systems to include but not limited to; applications & phone such as HP_CHATs & telephony Infrastructure across National sites.
This will include pre-implementation & post implementation testing & support, as needed.
Travel maybe required.
Support recruitment efforts in conjunction w/ the Operations Managers in the interviewing & hiring process of Health Plan Service Specialists, as needed.
Conducts financial impact analyses of contracts.
Develops & provides reports to understand issues & trends being raised by providers.
Prepares routine & special reports for Regional Management personnel.
Performs special projects, reconciliations, research, & analysis.
Prepares, implements, presents clear, succinct written & oral summaries, tables, charts &/or presentations on analysis to KPMAS staff & external parties.
Possesses & maintains knowledge of provider payment methods & health care data.
Possesses & maintains an excellent working knowledge of information systems, database development & analytic software & tools.
Research, review and resolve accounts, collect payments, set up payment plans, make appropriate adjustments.
Review claims per the patient's benefits according to the contract.
Supports the development of standard reporting packages & ad hoc reports for use in monitoring financial & operational performance including development of performance benchmarks & written descriptions of variance from benchmarks.
Provides support to regional health plan leadership in developing comprehensive business case analyses for strategies, initiatives & operations improvements.
Leads data collection & analysis for Health Plan Delivery System Operations.
Partners w/ other analysts & data owners throughout the organization to decipher data requirements.
Contacts key individuals in the organization to assist in data gathering efforts.
Designs & develops reports & data models using a variety of database applications & tools to extract data.
Works closely w/ Operations consultants & other's in the HP delivery system to accomplish key business strategies for the region.
Recognizes & works effectively in complex, political & ambiguous situations.
Uses organization & personal influence strategies to encourage desired behavior among those involved to reach goals of project.
Reviews documents in Spanish, translates and provides information in Spanish to members and other staff.
Night AuditorJun 2009 to Feb 2011
Greet guests and complete the registration process to include, but not limited to, inputting and retrieving information from the computer, confirmation of guest information and room rate, selection of rooms, coding electronic keys, promoting marketing programs, providing a welcome packet and ensuring guest knows location of room and/or has a bell person accompany him/her.
Assist guests with check-out including, but not limited to, ensuring rooms and services are correctly accounted, using the point-of-sale system, handling money, processing credit and debit cards, accepting and recording various forms of payment, converting foreign currency, making change and processing gift certificates and cards.
Demonstrate a thorough knowledge of hotel information including, but not limited to, room categories, room rates, packages, promotions, the local area and other general product knowledge and answer guest questions and inquiries.
Confirming reservation, assigning room, and issuing and activation room keys.
Process all payment types such as room charges, cash, checks, debit, or credit.
Process all checkouts including resolving any late and disputed charges.
Answer, record, and process all guest calls, messages, requests, questions, or concerns.
Communicate parking procedures to guests/visitors and dispatch bell staff or valet staff as needed.
Run daily reports and check for accuracy.
TeacherSep 2008 to May 2009
Central Avenue Bilingual Preschool.
TellerJul 2008 to Apr 2009 Virginia Commerce Bank
Making sure members receive friendly, accurate, and timely assistance by following guidelines, laws and procedures.
Actively markets bank products and services to customers within the branch.
Schedules prospect appointments either through initial contact or through follow up phone calls.
Closes sales by engaging prospects in new or enhanced banking relationships.
Opens and processes new demand and time deposit accounts including passbook accounts, IRAs, certificates of deposit, and money market accounts.
Issues counter checks, performs changes of address, redeems savings bonds, conducts money transfers, provides access to safe deposit boxes, receives loan payments and sells/ buys foreign currency.
Provides consumer and small business customers with information on deposit accounts, rates, service charges, restrictions and other relevant account information.
Receiving and processing members financial transactions, including deposits, withdrawals, and loan payments; sells money orders and traveller's checks to members, transfer amounts from member accounts as directed.
Posts transactions to member's accounts from member accounts as directed; cross selling services, performing a variety of miscellaneous tasks including typing, Filing, and computer input and answering the telephone.
Welcome members and provides routine information concerning services and directs members to appropriate department for specific information and service.
Balance cash drawer and daily transaction; performs other related duties as assigned.
ATM and Vault experience.
High School DiplomaJUN 07West Springfield High School － Springfield, VA
Northern Virginia Community College － Alexandria, VA
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