Experience

ArmadaCare

• United States
• Insurance
• 1 - 100 Employee

• Health Insurance Navigator

  • Jul 2022 - Present

  • Primary contact in handling routine and complex policyholders' inquiries, regarding signature authorization, benefits, claims, and general assistance. • Enroll Medicare recipients into health plans by probing to find which benefits will meet their needs and simplifying multifaceted plans for a better consumer experience. • Utilize problem resolution and negotiating skills to de-escalate any irate customers. • Outperform Quality Assurance approval benchmark at 95% during auditing. • Primary contact in handling routine and complex policyholders' inquiries, regarding signature authorization, benefits, claims, and general assistance. • Enroll Medicare recipients into health plans by probing to find which benefits will meet their needs and simplifying multifaceted plans for a better consumer experience. • Utilize problem resolution and negotiating skills to de-escalate any irate customers. • Outperform Quality Assurance approval benchmark at 95% during auditing.



Option Care Health

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

• Network Operations Center Team Lead

  • Mar 2020 - Jun 2022

  • Increased productivity by 10% helping to expand employee usage of appointment-setting tools which included proper scheduling thereby reducing unnecessary overtime.• Proactively identified areas of opportunity for office managers to increase new clients and total return growth, establishing plans and methods to attain these goals.• Trusted to assist the VP of Operations with completing monthly/quarterly performance reports for stakeholders

• Pharmacy Programs Coordinator

  • Mar 2020 - Jun 2022

  • Promoted to Pharmacy Programs Coordinator in 2020. • Managed supply chain with new contract negotiations with service providers with a corporate discount of 18%.• Mediated processing disputes between sales offices and operations/systems departments.• Worked with change management and transition teams to implement training and integrated legacy systems with new systems and processes.



Aetna, a CVS Health Company

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Customer Service Representative

  • Apr 2017 - Jul 2018

  • Promoted to Customer Service Representative in 2017. • Conducted peer-to-peer appeals with medical directors at the insurance companies for denials.• Responded promptly to telephone inquiries within the set departmental staffing and time parameters.• Familiarized and provided information on general Medicare eligibility and information.

• HEDIS Specialist

  • May 2011 - Jul 2018

  • Verified insurance benefits and explained patients’ individual levels of coverage as well as specific medical criteria.• Maintained knowledge of current accreditation, regulatory and healthcare quality, clinical practices, and quality measurement requirements and standards.• Provided persistent, effective, and assertive actions in resolving and appealing accounts while maintaining compliance with collections and HIPAA laws.