Manager Customer Service

Roberta Allen

Email: *********@********.***

Address: ***** **** **** ****

City: Carmel

State: IN

Zip: 46033

Country: USA

Phone: 810-***-****

Skill Level: Management

Salary Range: 100

Willing to Relocate

Primary Skills/Experience:

See Resume

Educational Background:

See Resume

Job History / Details:

Roberta M. Allen (Bobbie) 10902 Song Bird Lane

Cell 810-***-****

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

QUALIFICATIONS OVERVIEW

Over 20 years of experience in the insurance industry, and over 14 years of strong management background. Excellent computer skills and a self starter. Strong experience in various health product lines (HMO, PPO, and POS; CRC and Experience Rating methodologies). Additional underwriting experience in the Individual Market, Employee Assistance programs, and Managed Behavioral Health products. Responsible for enrollment, dis-enrollment, eligibility, and billing responsibilities for all lines of business and products. Developed internal controls and audits that support compliance, operational processes and requirements, with emphasis on timeliness, and accuracy. Excellent skills in operational processes, data analysis and all aspects of reporting and workflows.

EXPERIENCE Advantage Health SolutionsMay 2012 September 2012

Indianapolis, IN

Director of Underwriting Director of underwriting department responsible to adhere to Indiana small group regulations by auditing all renewals and new business groups. Implement any necessary changes in small group processes and rating modules. Assessed large group manual and experience rating module and processes, recommended and implemented changes. Developed and implemented Pooling charges for each pooling attachment point. Developed and implemented IBNR factors to be used in the experience rating module. Developed a financial rate adequacy tracking database in order to report all renewal and new business financial statistics. Responsible for assessing Chryslers 2013 renewal, and completing various financial impact analyses. Reviewed CAP funding, and risk sharing arrangements, for all owned networks, recommended and implement and necessary changes. Provided analysis for the development and implementation of a clinic model approach to reduce emergency room visit costs for various large groups.

Assisted in the development for an Individual HMO product and oversee the underwriting and reporting in this area. Manage and maintain the department budget, ensuring the adherence to the companys annual goals and objectives. Manage employees performance, training, development, and goals for all direct reports.

HealthPlus of Michigan July 2006 May 2012

Flint, MI

Underwriting Manager

Management of underwriting department, responsible to ensure rates are adequate for potential membership growth. Main focus is working on large cases ranging from 250 to 15,000 member life groups. The larger groups greater than 10,000 members are related to the auto industry. Assisted in the development of an on-line rating engine, for groups up to 99 eligible employees. Responsible for the development, maintenance, and processing of financial tracking, reporting, audit process, and training programs. Implemented underwriting guidelines, various policies and procedures for the department. Complete annual rate filings with the state. Responsible for corporate revenue budget by setting estimated per member per month yields for all commercial new and in-force groups. Analyze monthly revenue schedule to determine reasons for large variances. Developed TPA pricing by each service provided, and assisted in the development of an experience-rating module, and processes. Complete contribution, and premium off-set analysis, along with special risk arrangements and pricing benefit changes for HMO and PPO products. Provide data analysis for competitor pricing regarding hospital, provider discounts, access fees, and stop loss fees, compared to HealthPlus fees for self funded opportunities. Assisted in the development of an online system for an Individual PPO product and oversee the underwriting and reporting in this area. Manage and maintain the department budget, ensuring the adherence to the companys annual goals and objectives. Manage employees performance, training, development, and goals for all direct reports.

Presbyterian Health PlanJune 2004 August 2005

Albuquerque, NM

Manager Underwriting Services

Management of underwriting and pricing activities to ensure the rates developed are adequate to meet the risks assumed and the companies profit objectives. Developed and launched market leading online application for medical underwriting and enrolling individual members, which resulted in the reduction of the application processing turnaround time from ten days to 1 day. Interpretation of and adherence to underwriting rules, guidelines, insurance laws, regulations, and rating methodologies. Responsible for the maintenance of the departments financial tracking, reporting systems, audit processes, training programs, enrollment, dis-enrollment, eligibility, I.D. Card maintenance, issuance and turnaround goals. andl4eHHanHanHHandled the processing, auditing and timeliness of billing reconciliation and analysis. Managing employees performance, training, developmental plans and goals for all direct reports. Manage and maintain the department budget, ensuring the adherence to the companys annual goals and objectives.

Horizon Behavioral ServicesJuly 2000 May 2004

Lewisville, TX Underwriting Manager Management of underwriting, premium rate setting and financial reporting for a Behavioral Health Services organization with 3.5 million members. Oversees, monitors and reports on overhead costs that are used in the pricing calculation of all product lines, ensuring the profitability of HBS. Responsible for tracking all costs, productivity, renewals, new sales, proposals, and all aspects of account management, and communication materials through the development and implementation of databases. Responsible for reporting on all patient activity, days and visits per 1000 members by contract, provider, and facility. Monthly new sales, renewals, up-sells, and terminations are reported to monitor increases and decreases in membership, revenue, claims cost, and gross profit. Performed monthly audits on payments to hospitals, providers, members, and vendors, to ensure processing accuracy. Analyzed provider rate changes to provide annualized cost impact to the president prior to completing contract negotiations.

Presbyterian Health PlanApril 1999 June 2000

Albuquerque, NM Manager Underwriting Services

Management of underwriting and premium rate setting for the small group book of business, including interpretation of and adherence with small group underwriting rules, guidelines, insurance laws, regulations, and rating methodologies. Responsible for the development and implementation of the underwriting departments financial tracking and reporting systems, spreadsheet applications, audit processes, training programs and documentation requirements. Underwrote large group cases not requiring experience rating.

Sierra Health ServicesOctober 1993 April 1999

Las Vegas, NV Manager Contract Issuance Department 10/97 4/99

Responsible for the development and maintenance of the departmental budget. Monitored the compliance of state mandates and legislative changes to ensure all member communication material and I.D. cards sent to the customers were in compliance with the most recent D.O.I. filings.Assisted in the development and implementation of the member communication material and I.D. card automation process. Developed access databases for tracking of workflow, contract signatures, incorrect ID cards and group transmittal audit. Created access reports for weekly production, budget variances, FTE justification, daily flagged members, and performance guarantees. Developed and implemented policies and procedures to ensure consistency and accuracy. Underwriting System Specialist 8/96 9/97

Assisted actuary in compliance testing for small group certifications in multiple states. Developed access database for financial and workflow tracking. Developed internal audit database to track departmental consistencies and training needs. Assisted in the development of internal processes for reporting procedural and financial accuracy. Developed and maintained the medical underwriting database and reporting functions. Audited 20% of all underwriters new groups and renewals. Underwriter 6/94 7/96

Assisted in the Federal Group rate reconciliation and proposal process. Assisted in a seven-year internal audit for the federal employee program. Underwrote new small group business for HMO/PPO/POS, and Indemnity product lines. Developed renewal rates for small employer groups in multiple states. Assisted in the development of the small group underwriting guidelines manual.

Underwriting Coordinator 10/93 5/94

Gathered claims information for renewal process. Processed initial renewal and new group rates. Processed weekly production reports, logged and distributed daily work. Automated renewal process.

State Farm Insurance CompanyJuly 1992 - October 1993

Las Vegas, NV

Customer Service Representative

Serviced 3,500 Property, Casualty, and Life clients. Underwrote whole and universal life policies for $100,000 and less. Underwrote a minimum of 30 Casualty and 5 Property policies per week.

Firemans Fund Insurance CompanyMarch 1988 June 1992 San Diego, CA

Customer Service Representative

Responsible for billing analysis, customer questions, and amendment processing. Monitored and reported scheduled jewelry in and out of vaults. Reviewed all homes up for renewal ensuring all necessary riders and endorsements were purchased at time of sale. Sent out renewal proposals accordingly, and priced electronic and manual property applications and amendments.

Four Winds EnterprisesFebruary 1984 February 1988

San Diego, CA Claims Manager

Managed the processing of commercial and military freight claims. Inspected all damaged furniture.

Worked with appraisers regarding items damaged beyond repair and missing items in order to assess customers appraised values. Monitored all customer and vendor payments. Worked with the transportation offices on various military bases to service customers with late and damaged shipments. Maintained departmental budget, and processed all reinsurance claims.

EDUCATION

Madison High School September 1974 June 1977 Graduated with Honors and R.O.T.C. Rank of Captain Mesa College July 1977 April 1979 Business Management Coursework

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