Experience

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  Highmark Inc.

  • United States
  • Insurance
  • 700 & Above Employee

  • Strategic Provider Account Liaison

    • Jan 2023 - Present

  • Provider Account Liaison

    • Dec 2016 - Jan 2023

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  Benefit Design Specialists

  • Client Management

    • Jun 2008 - Apr 2016

    • Primary point of contact for all clients with questions or issues.• Coordinate follow up and provide a response to the clients on any questions or issues.• Review and analyze renewals for all assigned clients, including medical, dental, vision, life and disability insurance benefit renewals.• Obtain appropriate documentation from the clients to request competitive carrier quotes.• Provide internal staff with the appropriate documentation for each carrier with the plan designs to complete the quote process.• Provide internal staff with renewal documentation and carrier options to prepare proposal information.• Present the competitive quote options to clients and review the carrier specific information as it relates to the client.• Support clients through renewal process, including the completion of group and individual applications, termination letters to prior carriers, gathering UC-2 and corporate tax information to accompany applications for insurance, etc.• Obtain carrier specific detailed information (employee and employer packets) from carriers for the client elected benefits.• Present benefits during employee open enrollment meetings at the client’s request• Provide clients with periodic updates on the status of health insurance (i.e., Mid-Year MERP reviews, utilization reports from carriers, quarterly reviews with carriers and clients, etc.).• Keep clients apprised of carrier updates and industry news that impacts their business and their employees.• Provide support to all internal staff researching client related issues, including, but not limited to MERP, COBRA, Section 125 plans and supporting documentation.• Support requests for carrier and/or administration information and be available for benefit questions at client sponsored events, including health benefit fairs.• Organize and maintain client files and supporting documentation.

• 

  Alpha Benefits Group

  • Client Services Manager

    • Dec 2004 - Jun 2008

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  Highmark Blue Shield

  • United States
  • Insurance
  • 700 & Above Employee

  • Staff Services Supervisor

    • 2001 - Dec 2004

    Provide supervision for a team of business analysts assigned to lead projects in support of the medical and vision claims processing system and interfaces to external systems. Encourage personal development of staff members and provide technical direction on projects of various size and composition. Recognize team members for their team contributions and their individual successes.• Provide feedback to direct reports related to their level of project and research support, accuracy and opportunities for improvement to ensure career progression• Effectively juggle multiple priorities and adapt quickly to environmental fluctuations• Built solid relationships based on mutual respect• Work closely with the supervisory team to develop consistent approaches to project support

  • Staff Services Business Analyst

    • Jul 1997 - Jul 2001

    Provided business and project support for medical claims processing system initiatives. As a member of the Managed Care team, utilized knowledge of professional and institutional claims processes to develop and lead large project work plans for modifying systems processing, file layouts or design new systems. Utilized analytical ability and product knowledge to research production issues for internal and external customers.• Documented, tested and supported enhancements to the weekly Paid Claims File• Led project initiatives related to the sale of Managed Care business to Independence Blue Cross and business migration• Worked closely with Design Consulting to identify and implement a process for performing systematic claim adjustments• Provided internal and external customers with custom reports

• 

  Highmark Blue Shield

  • United States
  • Insurance
  • 700 & Above Employee

  • Supervisor - Customer Service East

    • 1995 - 1997

    Provided supervision for a production unit responding to customer inquiries via written correspondence and telephone. Encouraged personal development of staff members. Supported the quality improvement process. Recognized team members for their accomplishments.• Built relationships based on mutual respect• Provided feedback to staff related to their personal service level, accuracy and opportunities for improvement to ensure career progression• Worked with the supervisory team to develop consistent production and accuracy standards• Effectively juggled multiple priorities and adapted to environmental fluctuations

  • Customer Service Business Analyst

    • 1994 - 1995

    Represented Customer Service on multiple project implementations. Acquired an in depth knowledge of BlueCard processing and adjustment flows, traditional and managed care business, as well as systems supporting claim and inquiry processing areas. Established, documented and trained workflow processes for customer inquiry resolution.• Demonstrated excellent project management and organizational skills• Displayed outstanding communication skills by coordinating customer service system enhancement projects for Management prioritization• Showed initiative and creativity by submitting several processing enhancement requests to Staff Services

  • Customer Service Technical Assistant

    • 1991 - 1994

  • Customer Service Phone Representative

    • 1989 - 1991

  • Claims Processor

    • 1988 - 1989