Experience

ArmadaCare

• United States
• Insurance
• 1 - 100 Employee

• Director of Administration

  • Aug 2019 - Present

  About ArmadaCare A leading insurance program manager, ArmadaCare delivers uncommon insurance solutions designed to enhance ordinary health benefits. With the steadfast belief that insurance should be better, ArmadaCare’s plans fill voids in coverage for routine and unexpected healthcare expenses, offer valuable health and productivity support services and invite usage with modern conveniences, education touchpoints and people-first service. The result gives our clients the edge they need to retain, recruit and reward talent at all levels. Show less



CareFirst BlueCross BlueShield

• United States
• Insurance
• 700 & Above Employee

• Operations Manager

  • May 2017 - Jul 2019

  - Manage and leads daily activities of an operations area of business. - Maintain a high level of member, provider, and account satisfaction and retention by leading associates responsible for handling processing claims or enrolling accounts for members, providers, group administrators, brokers and customer service inquiries. - Responsible for all aspects of the section’s operation, including service to accounts, members, providers, claims adjustment and clerical workflows. - Ensure that staff receive training, guidance, direction, support, and development, in order to obtain targeted results. - Ensure that a consistent, high quality, timely and cost-effective level of service is provided, and that all internal and external goals and objectives are met. - Coordinate cross-functionally with a wide range of areas to meet customer needs, implement projects, addresses service/processing issues, improves quality of service, and implements useful and improved technology. - Represent the Operational area on a wide range of corporate initiatives. - Coordinate and develop policies, as well as the relationships, between the areas managed and other departments of the corporation (such as Sales, Medical Affairs, Systems Analysis and Planning, Network Management, Contract Compliance, Legal, etc.) in order to: facilitate the exchange of information, provide competitive analysis and product planning, aid strategic initiatives, ensure customer and provider service issues are taken into consideration. Show less



ArmadaCare

• United States
• Insurance
• 1 - 100 Employee

• Claims Manager

  • Aug 2013 - May 2017

  - Oversee, plan, develop, implement and maintain the Claims Administration functions and related processes of the Health Plan while ensuring 1) the integrity of the claims payment and adjudication process and 2) claims are processed accurately and timely for reimbursement to the Health Plan Providers and members, in accordance with contracted fee schedules and covered benefits as specified in the member evidence of coverage - Mentor and develop Health Plan staff toward expansion of job roles in order to meet the continuous challenges and changes of the health care environment, contracts and governmental regulations, including promoting the ability to respond effectively to innovative initiatives - Managed the migration of previously outsourced accounts from other TPAs in-house, - Responsible for strategic operational goals of increasing member value, supporting client acquisition and renewal Show less



Fringe Benefits Management Company A Division of WageWorks

• Tallahassee, FL

• Manager

  • Dec 2010 - Aug 2013

  Manage and oversee activities of the claims processing team, which includes defining and/or enforcing policies as well as setting standards for the timely receipt, review, research and resolution of claims issues. This includes Flexible Spending Accounts, ARA, Commuter, and other employee benefits claims. Manage and oversee activities of the claims processing team, which includes defining and/or enforcing policies as well as setting standards for the timely receipt, review, research and resolution of claims issues. This includes Flexible Spending Accounts, ARA, Commuter, and other employee benefits claims.



FBMC Benefits Management

• United States
• Insurance
• 100 - 200 Employee

• Enrollment Benefits Manager

  • Sep 2007 - Nov 2010

  Responsible for the overall direction and management of all aspects of the enrollment and eligibility operations department and enrollment and eligibility client relationships to ensure that clients are satisfied with products and services. This includes but is not limited to the management and direction of innovative consulting services for employee benefits and Section 125 Plans as well as ongoing employee benefits plan administration and customer service. Responsible for the overall direction and management of all aspects of the enrollment and eligibility operations department and enrollment and eligibility client relationships to ensure that clients are satisfied with products and services. This includes but is not limited to the management and direction of innovative consulting services for employee benefits and Section 125 Plans as well as ongoing employee benefits plan administration and customer service.



Skadden, Arps, Slate, Meagher & Flom LLP and Affiliates

• United States
• Law Practice
• 700 & Above Employee

• Sr. Benefits Specialist

  • Aug 2005 - Sep 2007

  Administer employee benefit programs in accordance with carrier contracts including medical, dental, life insurance, FMLA, COBRA, FSA, retirement (pension and 401k), and short and long term disability. Responsible for compliance with federal, state and local regulations affecting health, welfare and retirement benefits and adherence to established company policies. Provide customer service in response to complex employee, dependent, vendor and retiree inquiries and escalated issues. In addition, Provide project support as needed to implement new programs or changes to existing benefits and demonstrates continuous effort to improve operations, decrease turnaround times and streamline work processes. Also, provide support (communications, coordination with local sites, etc.) for the Company-sponsored Wellness program, Healthy Living. Show less



Guardian Life

• United States
• Financial Services
• 700 & Above Employee

• Disability Claims Examiner

  • Sep 1997 - Nov 2001

  Interpret medical and contractual information in the assessment of benefits payable under disability contracts. Provides excellent customer service both in written and verbal communications. Interpret medical and contractual information in the assessment of benefits payable under disability contracts. Provides excellent customer service both in written and verbal communications.



Standard Security Life Insurance Company of New York

• New York, NY

• Disability Claims Examiner

  • Nov 1989 - Sep 1997

  Responsible for obtaining and analyzing information to make claim decisions and payments on LTD, STD, Voluntary disability and WOP claims. Develop and apply appropriate claim and disability management techniques to ensure prompt and accurate payment decisions and management of disability claims. Provide responsive customer service to claimants, policyholders, brokers and internal departments. Responsible for obtaining and analyzing information to make claim decisions and payments on LTD, STD, Voluntary disability and WOP claims. Develop and apply appropriate claim and disability management techniques to ensure prompt and accurate payment decisions and management of disability claims. Provide responsive customer service to claimants, policyholders, brokers and internal departments.



Prudential Bache Securities

• New York, NY

• Account Specialist for Retiree Benefits

  • Aug 1988 - Nov 1989

  Administer retirement plans including calculation and review of pension benefits, resolution of retiree and employee questions/issues. Administer retirement plans including calculation and review of pension benefits, resolution of retiree and employee questions/issues.