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LAFAYETTE D. POPE Human Resources and Benefits Specialist

ac7u6b@r.postjobfree.com. www.linkedin.com/in/lafayette-pope-7613b056/. 804-***-****. Charlotte, NC 28226 Creative, ambitious professional with extensive Human Resources and Benefits experience. Analytical professional skilled in identifying the root causes of issues and translating complex processes into clear, understandable and actionable steps. Strategic leader able to guide diverse teams in analyzing and resolving sensitive issues. Areas of Expertise include:

• Benefits Administration

• Training and Development

• Strategic Planning

• Employee Relations

• Organization Development

• Recruitment

• Performance Management

• Project Management

• Microsoft Office

Professional Experience

Maestro Health. Charlotte, NC

CUSTOMER ADVOCATE 2018

Instructs employees/employers’ selection, enrollment, and comprehension of their medical benefits. Equips human resources departments with tools they need through one partner, one service team, one platform, and one portal. Consulted management with recommendations to improve the level of service for our clients, internal workflows, and interactions. Investigates provider/member benefit administration inquiries for resolutions in accordance to contracts and Federal/State laws.

Key Accomplishments:

• Manages benefit and claim inquires ensuring accurate and timely responses.

• Maintains confidentiality of information contingent upon HIPAA guidelines and reports any breaches.

• Provides guidance to patients reconciling patient liabilities with providers.

• Establishes and strengthen relations between patients and medical providers; colleagues and managers.

• Develops workflows/strategies for accurate benefit quotes and reconciliation of abrasions.

• Revises training material to assist representatives with service relations. A point of contact for discrepancies and clarifications of incumbent advocates.

• Submits presentations to alleviate customer service abrasions and bolster succinct comprehension of the healthcare industry.

• Supervises inquiries to ensure resolutions within 72 business hours and follow ups are completed with our clients.

• Ensures all proper paperwork is completed for proper claim payout contingent upon their benefits.

• Performs investigative research to improve employee relations and client relations.

• Audit internal documentation resources to ensure accuracy, clarity, cohesion based on corporate policies. 2

Lash Group Insurance. Fort Mill, SC

BENEFIT VERIFICATION SPECIALIST 2017-2018

Functional expert on Lemtrada payment billing/reimbursement coding and authorization protocols for patients diagnosed with Multiple Sclerosis. Completed outbound calls to initiate and complete the profiles of the patients. Key Accomplishments:

• Verified 8 patient insurance benefits coverage daily to ensure medical procedures are covered.

• Entered data of patient profile information resolving 93% of all discrepancies with other insurance carriers.

• Researched eligibility for medical benefits of patients and provide reports of findings to Site Coordinators.

• Investigated cost shares with billing CPT codes and preauthorization requirements.

• Maintained records with 100% accuracy of our patients in the Lemtrada treatment program.

• Educated and enrolled eligible patients into the charity program. Referred ineligible patients to other government/private assistant programs via patient relations. WellPoint-Anthem BCBS. Richmond, VA

IMPLEMENTATION COORDINATOR 2015-2017

Coordinated the execution of benefit implementation milestones for new accounts and renewals meeting the timeline. Collaborated with management and internal partners to ensure that program offerings were lucrative and within the budget parameters. Scheduled and facilitated meetings with internal/external partners to resolve any abrasions. Developed open

enrollment documentation and communication for our clients. Served as a consultant with Human Resources to create policies and administered medical benefits. Prepared and coordinated formal communications to new/existing clients regarding benefit plan offerings. Managed all cross functional changes to build benefit structures, claim processes, and training opportunities.

Key Accomplishments:

• Generated a 93% client retention renewal rate and increased the profit margin. Optimized open enrollment with more proficient activities improving cohesive relations.

• Supervised the benefit administrations with 100% compliancy with the Federal and Local legal guidelines i.e. Affordable Care Act, Family and Medical Leave Act, the Health Insurance Portability and Accountability Act and the Employee Retirement Income Security Act.

• Developed benefit implementation training sessions. Improved the completion status to 90% by Open Enrollment.

• Conducted operational market trends research and interviews for benefit plans with management. Revised medical benefit offerings, improved service times, and retained 92% of our clients.

• Generated reports to management depicting current performance status’, growth opportunities, training material revisions, succinct communications with internal/ external relations.

• Strategically devised with management tactics to improve the benefit implementation process and communications internally/externally.

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• Collaboratively created project plans for successful completion of deliverables and implementation. 85% of the groups were successfully implemented within the specified timeline.

• Negotiated successfully 40 client contracts to structure and administer medical benefits. Diffused potential partnership abrasions.

• Diffused any abrasions/issues to ensure successful and productive implementations.

• Innovated lucrative opportunities which improved employee relations, revisions of implementation workflows, and productivity monthly portfolio.

• Completed employee manuals which comprised HIPAA guidelines, explanation of benefits, and appeal/complaint procedures.

• Performed interviews with clients to obtain metrics of impact on delivery of rendered services.

• Assisted with the facilitation of the on boarding process of the employees with their medical plan packages.

• Completed job evaluations to ensure and improve proficiency.

• Investigated employee inquiries/issues with employers and medical providers. RECRUITER/SENIOR CUSTOMER ADVOCATE 2003-2015

Investigated and resolved member eligibility, coverage, service and claims issues in a timely manner. Advocated for members and providers on explanation of benefits. Conducted operational market research and generated reports of service improvement opportunities. Worked with management to recruit employees, resolved employee inquiries, facilitated training and incentive programs. Managed membership, claim, and benefit profiles. Implemented services strengthening patient relations.

Key Accomplishments:

• Completed, with a panel, job descriptions for 3 areas of our business unit.

• Reviewed resumes. Interviewed applicants for compatibility and expanded a diversified culture of our business unit.

• Revised and facilitated new hires onboard training/orientation. Developed learning objectives that increased the comprehension and proficiency percentage.

• Advocated for associates’ inquiries/issues to management improved employee retentions, employee relations, and morale.

• Initiated associate activities and correspondences with management improving relations and productivity.

• Assisted with management on forecasting staffing needs, role evaluations, interviewing, and recruitment. Drafted efficient methods to recruit prospective associates and strengthen culture diversity.

• Reduced legal abrasions by ensuring all representatives are compliant with the Health Insurance Portability and Accountability Act.

• Trained advocates in our department improving soft skills performance tactics. Average handle times to 2 minutes 40 seconds and improved first all resolutions to 85%.

• Audited telephone calls of the Customer Advocacy Department. The department was 88% compliant with the Health Insurance Portability and Accountability Act and accuracy percentage was 92% for benefit administrations.

• Reduced the expenditures of our business unit as an active member of a special committee. Revamped workflows and protocols.

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• Diffused explanation of benefit abrasions between members and providers. Offered billing reconciliations and investigated appeals/complaints of the patients.

• Completed performance evaluations to gauge metrics of our department. Education & Training

Master of Business Administration, Public Administration STRAYER UNIVERSITY Glen Allen, VA

Bachelor of Arts Degree in Human Resources STRAYER UNIVERSITY Glen Allen, VA

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