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Customer Service Health Insurance

Location:
Springfield, MA
Posted:
January 13, 2014

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Resume:

Carole A. Youmans

PO Box **

West Springfield, MA 01090

413-***-**** acb4t2@r.postjobfree.com

summary

Highly motivated, self-directed Analyst and Administrative Account

Specialist with over 10 years of diversified experience in corporate

finance and the health insurance industry. Skillful research,

investigative and reporting expertise. Exceptional analytical, problem

solving and decision making skills. Provider of high quality, high volume

work output with ability to handle multiple tasks and deliver on deadlines.

Recognized for excellent organizational abilities as well as attention to

detail.

PROFESSIONAL EXPERIENCE

Adecco - USA, East Windsor, CT

Current

Adecco USA is the leading staffing recruiting agency that provides

workforce solutions, direct placement and exiting careers with top

employers.

Test Center Administrator

Ensures the validity of testing services by proctoring and controlling the

computer based test center environment. In addition to completing CPR

reports outlining system issue in relations to exams taken by candidates,

customer service.

Administrative Accounting

Remote Deposit Capture, applying ARC General Ledger codes to RDC

transactions, scanning checks, completing deposits, ACH, Credit Cards and

Cash Payment at the Red Cross for Hurricane Sandy.

United Personnel, Springfield, MA

2013

Provides client staffing solutions in administrative, clerical, accounting

and medical office fields.

Benefit Administration - Human Resources

Implementation of employee benefits as it relates to new hires,

terminations, health insurance, 40lk processing and life status changes.

Data extraction, file feeds to vendor sites (dental, pharmacy, vision,

medical and Cobra), customer service, invoicing and accounting. Performed

system audits and reporting of data, Lawson HRIS system.

AETNA- Hartford, CT

2009 - 2011

Senior Analyst

Assisted Employee Assistance Program (EAP) Account Executives and EAP

Manager to develop and implement a monthly accounts receivable tracking,

reporting and resolution process to collect aged receivables timely and

efficiently.

. Implementation of policy and procedures.

. Processed daily cash receipts and applied cash/wires to appropriate

customer accounts (75 - 100 daily).

. Ensured collected reconciled dollars were allocated across benefits and

billing structures, Oracle A/R Application System. Updated and

researched Plan Sponsor data, Incedo Application System.

. Researched, resolved and responded to product inquires via mailbox, email

and telephone calls.

. Consulted with internal and external customers to identify accurate

account/benefit structure and issue resolutions.

. Accurately managed Open and Unidentified receipts (revenue reporting)

weekly, reconciliations, W-9 filings, and write-offs.

. Aged receivables greater than 60 & 45 days reduced from January 2010

through December 2010 (over $100,000).

. Made 25 - 30 outbound business to business collection calls per day.

Carole A. Youmans Page Two

CIGNA Corporation, Bloomfield, CT 2004 - 2009

Connecticut General Insurance Corporation, a company that provides health

care and related benefits offered through the workplace.

Account Installation

Managed the end-to-end process for consumer reporting; monthly and

quarterly health statements. Products, Health Reimbursements, Flexible

Spending and Healthy Awards Accounts (incentives and disease management).

Supported the implementation/installation of new business, structure,

eligibility and reporting.

. Coordinated the scheduling, tracking, and ordering for 300 + consumer

accounts.

. Subject matter expert for the implementation of the Incentive process for

Health Reimbursement customers.

. Responsible for the tracking, reporting and loading of incentives.

. Assisted Project Mgr with the new Incentive Engine procedures, processes,

and migration.

. Created and collaborated on formal audits procedures and documentation.

. Resource for external and internal issues, regarding monthly reporting,

and quarterly statements for all key clients and was considered the go-to

person for resolving customer inquiries.

. Successfully trained 20+ auditors on audit process and platform systems.

. Coordinated and distributed the audit assignments to internal personnel,

reviewed findings.

. Provided technical support for platform system; assisted with business

requirements, testing, release activities, data files, claim fallout,

root cause and gaps in process.

. Assisted Production Support and IT on issues/resolution, release

initiatives/projects, Vantives and Service Request Tickets (SRT'

. Worked with external customers in setting up EDI files transmitting

through E-commerce, converted to XML Excel spreadsheets.

. Assisted CQI Director & Project Manger with the implementation of an

automated reporting process which led to a new scheduling database.

. Identified opportunities and made recommendation for process/technical

improvements that reduced re-work and enhanced quality.

. Worked with Internal Training & Development as well as Outside Consultant

on release changes and an Access database in conjunction with an

automated scheduling process.

HP Hood, Agawam, MA

2002 -

2005

HP Hood LLC is one the largest branded dairy operators in the United States

Customer Service Rep (part-time)

Responsible for handling incoming and outbound calls in a call center.

Balanced and extracted routes for drivers.

SPRINGFIELD PUBLIC SCHOOLS, Springfield, MA 2004

A Culture of Educational Excellence, a large & diverse school system

Substitute Teacher

Responsible for carrying out the daily programs outlined in lesson plan

book for students K-12.

Carole A. Youmans Page Three

Specialized Training

. Interpersonal Processing Skills, Individual Processing Skills, Planning

Skills (short-term and strategic)

. Performance Intervention Systems (Needs Assessment Strategies, Content

Development, Diagnosis, Goal-setting, Selection, Training Delivery

Design, and Training Presentation Skills)

. Comprehensive Intervention Design.

. API - Aetna Process Improvement Certification (Yellow Belt) - 8/2010

EDUCATION

MA, Human Resource Development, American International College,

Springfield, MA

BBA, Business Administration, American International College, Springfield,

MA

Executive Secretary Certificate - St John's School of Business, West

Springfield, MA

Reference available upon request.



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