Customer Service Health Insurance
Resume:
SANDY Y. DAVIS
Perth Amboy, NJ 08861
Home: 732-***-**** *********@***.*** Cell: 732-***-****
OBJECTIVE
The opportunity to utilize my extensive managed care, health plan design
and benefit administration experience to provide cost effective human
resource solutions. I have proven success with maintaining client
relationships which has resulted in retention. Excellent interpersonal and
presentation skills.
PROFESSIONAL EXPERIENCE
BESSEMER GROUP, INC., Woodbridge, NJ 2006 - 2010
Human Resources / Benefit Administrator
Provided administration of health and welfare benefits to external client
(60) small employer groups. Researched and identified cost effective quotes
to present to the client.
. Assisted with the application process.
. Set up employee payroll deductions.
. Enrolled new hires, conducted orientations, followed up on
add/terminations.
. Managed and tracked all billing (45-50 multistate per month), A/R and
collections related to defined benefits.
. Reviewed Summary Plan descriptions for distribution.
. Resolved employee claim issues with health insurance carriers.
. Created personnel policy handbooks.
. Reviewed annual renewals and identified cost saving health insurance
options which saved clients an average of 4% on annual renewals by
implementing cost effective and comprehensive plan designs.
. Audited employee dependents for eligibility requirements.
. Notified and assisted with Medicare enrollment.
. Served as the liaison for Flexible Spending and Healthcare Spending
Account vendors.
GREAT WEST HEALTHCARE, Piscataway, NJ 2006
Senior Provider Relations Coordinator
Recruited and negotiated contractual agreements with Physicians and
Ancillary facilities.
. Investigated and resolved complex claim issues and appeals for the
adjudication of payment.
. Successfully conducted audits for National Committee for Quality
Assurance (NCQA) and Healthcare Finance Administration recertification
visits, and researched, compiled and reviewed health employee data
information set (HEDIS) in territory resulting in the achievement of full
NCQA accreditations.
. Was key point of contact for the cleanup and implementation of the new
claims system.
AMERIGROUP CORPORATION, Edison, NJ 2002 - 2005
Provider Service Field Representative
Worked as liaison between the health plan and network physicians.
. Conducted orientations and informational sessions with the medical office
staff.
. Recruited specialty providers needed for network deficiencies.
. Reviewed medical practices to confirm that they are in compliance with
the current HIPAA regulations.
SANDY Y. DAVIS
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Home: 732-***-**** *********@***.*** Cell: 732-***-****
EPIX, INC., Woodbridge, NJ 1999 - 2002
New Business Development Representative
Served as a liaison to new corporate client accounts and their employees.
. Conducted orientations with client employees to explain the employee
leasing relationship.
. Collected new hire paperwork to enroll employees onto the payroll system.
. Assisted with client underwriting of workers' compensation, credit and
benefits.
. Coordinated with other departments to ensure that new client information
is processed correctly.
. Audited new employee information for accuracy, and ensured all forms were
complete.
. Ran and reviewed first payroll.
. Delivered first payroll and explained all associated reports to client.
. Accompanied sales representatives on calls as requested.
OXFORD HEALTH PLAN, INC., Iselin, NJ 1997 - 1999
Provider Relations Field Representative
Developed and maintained relationships with Physician Network Providers and
their staff within a geographic area.
. Facilitated orientations on all Plan policies and procedures.
. Achieved quarterly goals for re-credentialing of network physicians
according NCQA regulations.
LIBERTY HEALTH PLAN, INC., Jersey City, NJ 1997
Provider Service Field Representative
Conducted Provider orientations and training to all participating Providers
regarding state mandated Medicaid requirements.
. Served as liaison between credentialing and marketing departments.
. Maintained provider database.
. Identified and resolved inquiries regarding Provider status.
. Developed Physician directories and all Physician related materials.
BLUE CROSS BLUE SHIELD OF NJ, Newark, NJ 1992 - 1996
Customer Service Representative
Processed HMO and major medical health claims in accordance with Plan
policies, procedures and contracts limits.
. Resolved inquiries from physicians, attorneys, subscribers and insurance
companies regarding the status of outstanding claims via telephone and
written correspondence.
. Responsible for the investigation and verification of COB, auto and
workers compensation related claims and the prompt recovery of
overpayments.
EDUCATION
BS, Marketing and Business Administration,
Delaware State University, Dover, DE
New Jersey Health Licensure
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