Director, Client Operations

• Dec 2017 - Present

Lead day to day operations functions of Association Health Plans. Ensure accurate and timely benefit administration including system changes, reporting requirements, and vendor notification. Submit required filings with the Department of Labor (DOL) and State Departments including rate filings through SERFF, Annual Registration, Plan Change Notices, M-1, and Disclosure to CMS Form. Ensure timely delivery of required member documents, annual notices, and notifications required by the plan, Federal Mandates, and Health Care Reform. Audit and update required plan documentation in accordance with changes in benefit plans, including changes to forms, amendments, summary plan description (SPD), Summary of Benefits and Coverage (SBCs), and benefit summaries. Oversee IRS 6056/6066 Employer Reporting including sending initial email notification instructions to employers, responding to phone and email inquiries, and sending corrections of 1094-B/1095-B forms. Collaborate with vendors to resolve escalated and complex level issues including benefit, claim, file and eligibility issues. Maintain and update the health plan website with plan documents.

Director, Insurance Operations

• Jan 2012 - Dec 2017

Oversee all operations and retention functions of $41 million NJ Association Health Plan, with over 10,000 covered lives. Ensure accurate and timely benefit administration including system changes, eligibility file changes, reporting requirements, and vendor notification. Submit 20 required filings with the NJ Department of Banking and Insurance (DOBI) and Department of Labor and Georgia DOBI annually. Responsible for managing timely delivery of required member documents, annual renewals, and notifications required by the plan, Federal Mandates, and Health Care Reform.Review and update required plan documentation in accordance with changes in benefit plans, including changes to forms, amendments, summary plan description, Summary of Benefits and Coverage (SBC’s), benefit summaries, and the website. Set and monitor performance metrics of operations team to ensure all targets are achieved or exceeded for quarterly renewals. Evaluates current policies and procedures and workflows to create efficiencies and promote continuous improvement. Oversee human resource functions, including interviewing, hiring, performance evaluations, performance plans, mentoring and leadership to staff. Communicate with internal departments about benefit plan changes to ensure identification cards, claims system, and customer service representatives are updated and benefits are administered accurately.

Manager, MEWA Operations

• Jan 2011 - Dec 2011

Account Executive

• Aug 2003 - Dec 2010