Quality Assurance Manager

Andrea M. Sligh

**** ********* ****** (***)***-

4503

Baltimore, MD 21214

*******@*******.***

SUMMARY Administrator of employee benefits health and life

insurance, dental and vision benefit, flexible

spending accounts, new and existing benefits programs, and

developing and presenting training sessions, and seminars.

WORK EXPERIENCE

EMPLOYEE ONE BENEFIT SOLUTIONS - Baltimore, MD

May 2007 - Present

Operations Manager/ Account Management

. Procured quotes from medical/dental/vision/ ancillary

carriers

. Led special projects as assigned including dependent

audits, quality audits, ongoing dependent verifications

and carrier file modifications

. Investigated and resolved problems related to

eligibility, processing and error reports

. Facilitated enrollment meetings

. Recommended and assisted in the development of office

methodologies, document/file format standards and

procedures

. Maintained day-to-day contact with assigned vendors and

clients along with document issues and root-cause

analysis to prevent recurrence

. Managed collection activities such as sending follow-up

inquiries and negotiated with past due accounts

submittal timetable

. Developed procedures and policies for office activities

and supply orders

. Oversaw procedures to ensure compliance with Federal and

state policies

FOSTER THOMAS INC. - Annapolis, MD September

2005 - May 2007

Marketing Coordinator/ Benefits Analyst - supporting Regional

Director of Office

. Managed vendor relations while researching

medical/dental/ancillary benefit plans

. Prepared new and renewal proposals using carrier

quoting/ portal systems to get carrier rates

. Familiar with ADP HRB system for benefit administration

. Implemented new and renewal groups for carrier

submission

. Provided account management support to client -

answering questions from client group or HR reps,

enrollment processing, along with reconciling client

invoices

. Assisted with employee benefit meetings and

communication pieces

. Acts as liaison between employees/retirees and insurance

carriers in resolving

billing and coverage questions

. Reviewed applicable accounting reports and accounts

payable register to ensure accuracy

. Supervised office activities to achieve maximum expense

control and productivity

. Ensured timely payments of vendor invoices and

maintained accurate records and control reports

LUMENOS - Alexandria, VA September

2004 - May 2005 Account Coordinator

. Participated in health & welfare benefit enrollment

meetings and preparation of these events.

. Worked with client services director to ensure that all

operation and key milestone deliverables are met.

. Acted as primary liaison to the internal and external

departments to resolve escalated customer issues, resulting in

an increase in client satisfaction.

. Drafted Summary Plan Document (SPD) and assisting client

until document is finalized

. Created monthly reports (claims lag, monthly experience,

etc) for assigned client accounts

GROUP BENEFIT SERVICES - Hunt Valley, MD November

2000 - May 2004

Associate Account Manager (Self - Funded)

. Prepared New or Renewal Business Transmittal

. Reviewed stop loss applications, or reinsurance

contracts

. Shopped rates for ancillary products

. Implemented pharmacy benefit manager set up on new or

existing groups

. Assisted with employee health & welfare benefit

meetings, communication pieces

. Advocated for resolution of group problems with internal

or external vendors

Product Management Data Analyst

. Maintained carrier plans, rates, benefits and service

area for web proposal support

. Set up, quality assurance and maintenance of carrier

plans, benefits, rates in GMS, AS400, and OnQ

. Documented procedures to support maintenance of rating

applications and broker data bases

. Tested quality assurance of rating applications and

populated a relational data base for benefit values

Magellan Account Administrator (Self-Funded)

. Provided administrative/customer service support to

Magellan Behavioral Health Employees and Thyssen Krupp

Elevator

. Processed billing & enrollment transactions

. Responded to written member inquires (employee and

management) by telephone and email regarding enrollment

applications and account status

. Audited carrier eligibility reports: Blue Cross Blue

Shield, Aetna US Healthcare, and Vision Service Plan

. Directed contact with carrier representatives, Blue

Cross, Aetna, for resolution of claim issues

. Held backup responsibilities for Magellan Flexible

Spending Accounts - medical and dependent care (May

-August 2001)

EDUCATION UNIVERSITY OF MARYLAND

Bachelor of Arts - Health Science and Policy

Pursuing the CEBS Designation

LICENSURE Maryland Life and Health

TECHNICAL SKILLS OnQ, AS 400, Microsoft Word, Excel, and PowerPoint,

Contribute Software, Salesforce Client

Management Database

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