Experience

UAW Retiree Medical Benefits Trust

• United States
• Non-profit Organizations
• 100 - 200 Employee

• Benefit Service Analyst

  • Dec 2013 - Present

  Project coordinator; Workers comp/subrugation coordinator; Test audit/survey coordinator Project coordinator; Workers comp/subrugation coordinator; Test audit/survey coordinator



Molina Healthcare

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Learning Facilitator I

  • Jul 2013 - Present

   Consults with plan/Corporate leadership in assessing and meeting specific training needs. Develops/Conducts training including both group facilitation as well as individual projects. Evaluates data and organizational needs to identify learning and development issues. Works with department management to design and implement improvements. Collects, records reports learning activities and employee progress. Acts as a back-up subject matter expert in at least two other training content area. Act a resource for all customers, if our team does not provide a solution to the identified need, take ownership of the request, and help the customer find the entity that does. Always display BEST of Service attitude



Molina Healthcare of Michigan

• Member Services/Claim Resolution Representative II

  • Jul 2011 - Present

  Confirm and provide Medicaid/Medicare subscriber eligibility, benefits and claims information to providers and subscribers. Research Medicaid/Medicare member/claims issues and interact with internal departments to resolve member/billing issues. Schedule appointments for transportation for members via Molina Healthcare’s transportation vendor.Add/change member’s Primary Care Physician (PCP) Confirm and provide Medicaid/Medicare subscriber eligibility, benefits and claims information to providers and subscribers. Research Medicaid/Medicare member/claims issues and interact with internal departments to resolve member/billing issues. Schedule appointments for transportation for members via Molina Healthcare’s transportation vendor.Add/change member’s Primary Care Physician (PCP)



Blue Cross Blue Shield of Michigan

• United States
• Insurance
• 700 & Above Employee

• National Account Liaison

  • Feb 1990 - Apr 2010

  National Account LiaisonResponsible for executing service encounters with National Accounts through direct interaction with their Human Resources staff personnel, as well as union personnel, third party administrators and agents. The main components of these service encounters include benefit and claims processing clarification, and employee education both internally and at national group locations.Initiate and redirect inquiries to Customer Service Representatives for subsequent resolution where direct intervention is required.Interacts directly with Marketing Account Managers and Benefit Analysts, as well as System Analysts to clarify and discuss the intent of group structures, benefit changes and eligibility matters.Ensure customer’s needs and expectations are met and facilitate improved servicing and customer satisfaction by interfacing with multiple BCBSM operation areas and our partner BCBS plans.Travel to account locations both nationally and within the State of Michigan to discuss critical problems and business issues, attend/conduct open enrollment meetings, health fairs, benefit and educational presentations, assist in resolution of benefit/claims issues and build positive relationships with customers.Identify system issues and initiate Problem Identifications (PIDs) as necessary to ensure claims are processed on the account benefit structures; monitor systems changes to ensure systems corrections are accurate.Support new business workgroup implementation, lead and/or support special projects to produce desired results, identify/analyze business problems and develop business cases for solutions, represent the department/division on work groups.Develop and improve workflow and business processes to improve customer servicing and decrease operational costs.Assist in improving the quality and timeliness of the departmental responses in an effort to meet Performance Guarantees.

• Customer Service Representative

  • Feb 1990 - Apr 2010

  Provide quality customer service to subscribers, providers and third party administrators (TPA) in a call center, walk-in and written environment.Confirm and provide subscriber eligibility, benefits and claims information to subscribers, providers and third party administrators.Obtain precertification and/or pre-authorization for certain procedures and pre-existing conditions.Adjudicate claims/COBRA Cash Payments accounts payable and accounts receivable