Experience

Concord Management Resources

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Senior Financial Analyst

  • Mar 2014 - Present

  Provides a thorough analysis to the Executive leadership with a monthly executive summary in eight core areas, Membership, Financial Metrics (Healthcare Fees, Underwriting Expense and Operating Expense on a PEPM/PMPM basis), Reserves, MLRs, Open and Pended claims, High Dollar Member Utilization, Claims Utilization by dollars paid (Paid & Incurred) on a Network basis and Utilization Statistics, on Year End, Year to Date and Year over Year performance. Measure Reserves set by our actuarial partners on a rolling monthly Incurred and Paid basis while applying discounts rates to billed amounts of Open-Pended, Medicare and duplicate claims offset by Reinsurance Receivables. Construct High Dollar Reports after merging Medical and RX claims via Pivot Tables and VLOOKUP while accounting for Stop-Loss (SPEC and Aggregate Deductible based on 12/24 contract) to combine with proprietary MARA Risk Scores and evaluate members ICD-10 diagnoses individually for future plan liability. Generate monthly, quarterly and daily business reports via SAP Business Objects and incorporate into enhanced reporting suite of KPIs gauging plan performance in areas of Sales, Operations, Financial and Utilization. Assist and work with vendors in the data warehouse development and maintenance thereof including the development of a data dictionary, assigning levels of importance and establish mapping to generate purposeful queries from systems being adopted and implemented. Evaluate and illustrate our MEWA plan against other in-house benchmarks (Health Republic NJ CO-OP) in MedInsight [Milliman] Chronic Conditions Hierarchical Groups (CCHGs) diagnostic grouper to identify Medical cost drivers in overall population health management objectives. Led Aetna Trend Guarantee initiative to secure reduced favorable rating. Responsible for incoming and outgoing data files from vendors via the established SFTP process and ensure data is loaded accurately and timely.



Gallagher

• United States
• Insurance
• 700 & Above Employee

• Benefits Analyst

  • Aug 2008 - Mar 2014

  Processed and administered HRA (Health Reimbursement Arrangements) claims. Forecasted HRA spend rates and liability on an annualized basis for budget purposes. Compiled data for UBA (United Benefit Advisors) surveys and client census in order to place competitive market bids with the major health insurance carriers. Prepared RFPs (Request for Proposals), review and summarize market bids to ensure healthcare quality while working to contain cost for mid-year and annual financial reviews. Prepared medical claims utilization reports for self funded groups to help implement a medical benefits strategy and financial recommendations. Worked with all levels of management and support the client installation process and maintaining of client records. Worked with client to help develop Medical Contribution Strategies to entice plan movement. Updated monthly medical and Rx loss ratios and prepare actual medical and Rx claims paid graph per employee with a two month set back on a three month and five month rolling average. Charted claims paid vs. premium collected minus retention to establish carrier’s profitability for use in leverage in negotiation on renewals. Maintained eligibility and process enrollment for select clients. Estimated quarterly IBNR (Incurred but Not Reported) reserves using industry standard estimated reserve weighted average lag method and completion factor method. Performed Accounting Report Audit while submitting weekly uploads (Transamerica) of 401(k) deferrals (Pre-tax & Roth), ER Safe Harbor match, 401(k) Loan Repayments and Catch-up Contributions while following guidelines on annual Contribution and Benefit Limits. Worked with our 401(k) Advisor helping to select a menu of funds by performing quantitative analysis of those funds using industry accepted metrics. Administered Section 125 Discrimination Test and produce Total Compensation Statements for select clients.



Norwescap

• United States
• Non-profit Organization Management
• 100 - 200 Employee

• Certified Tax Preparer

  • Jan 2006 - Apr 2008

  Filed individual returns-1040 (including applicable state returns) and Schedules A, B, C-EZ, D, E, EIC, R, SE and various credits. Interviewed clientele, reviewed financial and supporting documents, applied tax laws equitably and accurately and provided advice on future tax planning. Communicated tax discrepancies to NJ Department of Treasury (Division of Taxation) and IRS to resolve problems and identify solutions. Filed returns electronically through Self Select Pin Method, Practitioner Pin Method (Form 8879) and Form 8453. Managed new IRS site while assisting Electronic Return Originator at other locations. Handled all aspects of administrative duties including maintaining tax records of clientele, maintaining required files for audit purposes and responded to client inquires by phone.



Fulton Bank

• United States
• Banking
• 700 & Above Employee

• Customer Service Representative

  • 2006 - 2008

  Conducted all bank transactions including cashing checks, certifying checks, treasurer checks, money orders, accepting deposits, loan payments, 941 tax payments, processing withdrawals and many additional duties. Processed mail transactions to help ensure the smooth and efficient handling of information and answered through mail correspondence. Recorded currency-received tickets on a balance sheet, verify balance of accounts, and sort checks and deposit slips. Conducted monthly audits and daily vault reconciliations. Organized and catalogue signature cards, both for new and closed accounts. Managed accounts with FISERVE system, research and provide solutions for banking discrepancies within customer accounts with JH-Image retrieval process. Certified checks, maintained and filed folders of our business accounts, an the legality of documents. Processed and prepared paper work for I & EE Bonds and Traveler Checks. Processed background checks against Office of Foreign Assets Control database.