LiveCareer-Resume

patient benefit advisor resume example with 9+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
  • :
Summary

Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Skills
  • Family Education Programs
  • Crisis Intervention
  • Recordkeeping and Data Input
  • Critical Thinking
  • Team Building
  • ACA Standards Knowledge
  • Benefits Administrator
  • Project Management
  • Microsoft Office Suite
  • Team Building and Leadership
  • Handling Escalations
  • Supervision & leadership
Experience
Patient Benefit Advisor, 01/2022 to 04/2023
Beaumont HospitalsGarden City, MI,
  • Completed Family and Children Medicaid Applications, Aged Blind& Disabled Applications, SSI and SSDI applications for unfunded patients. Added new babies to Texas Stated Medicaid. Secured signatures for alien participants CHIP P 3038. Submitted financial assistance applications on patients behalf.
  • Offered premimum assistance for marketplace insurance and Cobra payments.
  • Provided assistance to plan participants by explaining benefits information to ensure educated selections.
  • Communicated effectively via email, phone and face-to-face with plan participants to resolve issues pertaining to health and welfare benefits.
  • Checked accuracy and completeness of benefits applications and documents.
  • Mastered state and Federal benefit laws Including ERISA, FMLA, COBRA, HIPPA and 401k administration.
  • Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
  • Answered questions and responded to inquiries to deliver high level of service to patients.
  • Kept operations in compliance with requirements by applying knowledge of applicable regulations, legal statutes and tax code information.
  • Performed in-depth investigations into personal backgrounds of applicants.
  • Informed applicants of other agencies providing useful or related assistance.
  • Maintained positive working relationship with fellow staff and management.
  • Conducted interviews with applicants, explaining benefits process and which programs were available.
  • Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
  • Explained eligibility details and affordability options to patients with kindness and respect.
  • Used Passport, TMHP, WPS, Artiva, Meditech, PME, SSA, Nexi Lexus, Market Place to compile and verify case information.
  • Certified Marketplace Health Exchange Insurance 2023
Benefits Verification Specialist/Mental Health Worker, 08/2019 to 04/2021
WarnermediaMI, State,
  • Completed risks assessments on members calling for mental health referrals.
  • Verified insurance benefits and copayments, created and authorized referrals for EAP and other benefit programs and inpatient/outpatient admissions.
  • Reviewed and researched claims for appropriate CPT, Revenue and Diagnosis Codes; sent claims back to be reprocessed when denied in error, educate providers and facilities on how to submit and correct claims timely, review payments and check inquiries
  • Oversaw enrollment of new employees and company-wide yearly enrollment period.
  • Mastered state and Federal benefit laws Including ERISA, FMLA, COBRA, HIPPA and 401k administration.
  • Kept operations in compliance with requirements by applying knowledge of applicable regulations, legal statutes and tax code information.
  • Administered employee insurance, pension and savings plans, working with insurance brokers and plan carriers.
  • Researched employee benefit and health and safety practices, recommending changes or modifications to existing policies.
  • Filed appeals and grievances on behalf of members.
  • Coordinated benefits processing, including enrollments, terminations and claims.
  • Provided assistance to plan participants by explaining benefits information to ensure educated selections.
  • Communicated effectively via email, phone and face-to-face with plan participants to resolve issues pertaining to health and welfare benefits.
  • Reviewed employee enrollments to verify accuracy, inputting information into company database.
Public Assistance Specialist/Texas Works Advisor, 06/2018 to 01/2019
Texas Health & Human Services CommissionCity, STATE,
  • Identified and verified income and resources to document financial status of applicants and determine eligibility.
  • Interviewed applicants and family members or authorized parties to collect information related to identifying need for program benefits.
  • Maintained client case records for detailed history of interactions and activity.
  • Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
  • Gathered financial information from clients regarding income, assets and debts.
  • Guided clients through transition to independent living within community.
  • Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
  • Explained eligibility details and affordability options to patients with kindness and respect.
  • Conducted interviews with applicants, explaining benefits process and which programs were available.
  • Informed applicants of other agencies providing useful or related assistance.
  • Processed benefits applications and documents for food stamps and medical assistance.
  • Calculated benefit levels and timespan of program eligibility based on established factors.
Fraud Analyst 11, 05/2017 to 10/2017
BC ForwardCity, STATE,
  • Reviewed customer accounts for possible fraudulent account activity
  • Used multiple data sources to derive end-to-end fraud performance metrics.
  • Analyzed and reviewed confidential and highly sensitive investigative material concerning various parties.
  • Connected patterns for underlying account associations to discover undetected fraud.
  • Made recommendations for closing accounts and performed associated follow-up.
  • Conducted reviews of flagged transactions and reports that showed potential suspicious activity.
  • Determined existing fraud trends by analyzing accounts and transaction patterns.
  • Served as primary contact for fraud claim inquiries.
  • Monitored real-time queues and analyzed high-risk transactions from specified points of sale within business portfolio.
Pension Analyst, 08/2016 to 11/2016
Willis Towers WatsonCity, STATE,
  • Supported financial advisors with administrative and client support assistance.
  • Administered employee insurance, pension and savings plans, working with insurance brokers and plan carriers.
  • Researched employee benefit and health and safety practices, recommending changes or modifications to existing policies.
  • Planned and completed group projects, working smoothly with others.
  • Demonstrated leadership by making improvements to work processes and helping to train others.
  • Assisted with customer requests and answered questions to improve satisfaction.
  • Understood and followed oral and written directions.
  • Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
  • Prioritized and organized tasks to efficiently accomplish service goals.
  • Informed [Type] team members about regulations and requirements for program participation.
  • Identified needs of customers promptly and efficiently.
Benefit Program Specialist, 04/2013 to 04/2016
Chesterfield-Colonial Heights, Social ServicesCity, STATE,
  • Scheduled and interviewed applicants and recipients by telephone and in person; obtained necessary information and determined initial and continued eligibility for state and federal financial and medical assistance programs (SNAP, MEDICAID, GENERAL RELIEF)
  • Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
  • Enforced operational compliance with state and federal laws
  • Granted, modified, denied, or terminated assistance based on key information and eligibility determination.
  • Documented family composition, citizenship status, income, age, identity, assets and other information as required
  • Communicated effectively via email, phone and face-to-face with plan participants to resolve issues pertaining to health and welfare benefits.
  • Gathers information, collects data and evaluates information for accuracy and consistency through current and third-party verifications
  • Contact’s collateral sources needed to verify information received from applicants
  • Interprets and explains benefit programs, regulations and procedures; explains applicant and recipient rights and responsibilities
  • Loaded funds to EBT cards.
Workforce Services Representative, 03/2011 to 03/2013
Virginia Employment CommissionCity, STATE,
  • Placed individuals in jobs based on skills, abilities and interests.
  • Delivered exceptional service level by listening to concerns and providing appropriate solutions.
  • Wrote job support plans with clients and provided follow-along supports to maintain client employment.
  • Developed and produced documents, reviewed and evaluated information to identify and remedy deficiencies.
  • Informed job applicants of duties and responsibilities, compensation and benefits.
  • Scheduled or conducted new employee orientations.
  • Reviewed employment applications and job orders to match applicants with job requirements.
  • Searched for qualified job candidates using computer databases, media advertisements or employee referrals.
Education and Training
Master of Public Administration: Public Administration, Expected in to Strayer University - Midlothian, VA,
GPA:
Bachelor of Arts: Sociology/Criminal Justice, Expected in to Virginia Union University - Richmond, VA
GPA:

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Resume Overview

School Attended

  • Strayer University
  • Virginia Union University

Job Titles Held:

  • Patient Benefit Advisor
  • Benefits Verification Specialist/Mental Health Worker
  • Public Assistance Specialist/Texas Works Advisor
  • Fraud Analyst 11
  • Pension Analyst
  • Benefit Program Specialist
  • Workforce Services Representative

Degrees

  • Master of Public Administration
  • Bachelor of Arts

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