Experience

Affinity Health Plan

• United States
• Insurance
• 300 - 400 Employee

• Enrollment Resolution Specialist

  • Oct 2015 - Present

  Responsible for EP Reinstatement, Reinstate/Term QHP and EP members as per NYSOH file received and premium payments made, provide detailed response of all adjustments/updates created•Assist with EP and QHP Issues Inbox, provide detailed response of corrections made•Review multiple Softheon Queues as per error indicated and correct member’s folder accordingly•Investigate NYSOH Compliance Issues and provide all corrections made•Route reinstatements back to NYSOH/ Trigger members downstream to IKA claims•Update IKA claims accounts accordingly as per Softheon and 834 files•Review accounts from the EP Reconciliation Report and update in Softheon/Facets if required•Assist in the quality review of the Monthly Refund Report, create financial adjustments when required•Responsible for all EP workflow pertaining to eligibility , billing and demographic, do all the necessary correction on the accounts• Train co-workers on how to reinstate/re-trigger/route/adjust members’ accounts accordingly Show less

• Quality Assurance Representative

  • Oct 2012 - Oct 2015

  Ensure the prompt and accurate enrollment into the plan of Members with problematic eligibility by researching, analyzing and resolving process issues and/or communicating with various department & agencies.•Conduct a quality review on enrollment applications and the supporting documentations provided in preparation for annual state and internal audits.•Preform outreach to applicants or field representative to obtain any additional documentation or verification needed in order to have the application meet all the requirements adhere by the state and compliance departments•Review data base to ensure that all the data entry coincides the eligibility given was correct and ensure that all external transaction were approved •Update newborn eligibly in the system and send information to HRA / LDSS for updates•Search for newborn hospital claims and verified if state premium was received Show less

• Retention Specialist

  • Apr 2010 - Oct 2012

  Responsible for outreach via email & phone to members and marketing department in efforts to assist them in maintaining the quality of their applications, •Handled and logged in to all inquiries pretending to applications status at a timely manor •Conducted outbound calls to dis-enrolled members in efforts to reenroll them in our programs•Responsible in completing all mailed- in application and as well as assisted all potential members walking into the corporate office.

• Call Center Specialist

  • May 2005 - Apr 2010

  Handled over 750 inbound calls monthly, •Prequalified any potential applicants informed them of the required documentations and coordinated appointments with field representatives closes to their area•Conducted call quality audits and provided hands-on training to new hires•Responsible for weekly and monthly report on the overall performance of the team using CMS



Affinity Health Plan

• United States
• Insurance
• 300 - 400 Employee

• Field Marketing / Recertification Representative

  • Apr 2003 - Jan 2005

  Conduct marketing in different venues mobile office, clinics, hospitals, and large public gathering. •Educate and enroll members of the community into state-funded programs such as Medicaid, Child Health Plus and Family Health Plus •Responsible for calculating the potential members’ income, collecting supporting documentation and premium if needed. •Conducted outbound calls and mail postcards to existing members notifying them and their upcoming renewal •Assisted members with filling up their renewal package and advised then of any changes in there coverage do to their current situations in a timely manner. •Responsible of maintaining files of clients to ensure accuracy of member’s qualification or disenrollment Show less