Service Representative Sales

Michele Jones

**** ******** ******, **********, ** 40216

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

Ph: 502-***-****

Summary

Innovative results oriented Benefits Professional with broad experience in

benefits administration, employee training, policy development, and

performance management. Highly effective working in fast paced environments

and collaborating with various levels of personnel, including employees,

managers, and executives. Exceptional employee relations skills with

demonstrated proficiency in program management, and contract negotiations.

Skills

Excellent Interpersonal and Oral Education and Training

C ommunication Program Development

S trategic Planning / Benefits Administration

I mplementation Wellness Coaching

C ontract Negotiations

O rganizational Development

Experience

Humana Louisville, KY

Large Group Account Advisor 1994 2014

P rovided consulting expertise, developed, and implemented employee

b enefit programs to 30 large group employers with diverse benefit designs

Assisted with health, life, dental, vision, COBRA,HIPAA, STD, LTD, FSA,

H SA, and work site plan administration

Performed audits of monthly reports from COBRA administrator to ensure

c ompliance with COBRA and HIPAA provisions

Served as a liaison for HR managers and employees with escalated billing

a nd claim issues

Informed HR manager on procedural or benefits changes

E ffectively evaluated plans to ensure client needs were being met, made

r ecommendations of necessary changes, and recommended improvements

Effectively worked to make sure clients plan operated smoothly

I nvestigated discrepancies and provided information in non routine

s ituations

Coordinated and managed orientation benefits presentation

O rganized and coordinated open enrollment for core and voluntary benefit

p lans

Implemented and managed wellness program

E xecuted and performed planning and coordination of annual health fair

D eveloped annual guidance plan through collaborative efforts, with

b roker and internal sales team for union/non union clients

Humana Louisville, KY

Senior Triage/Waiver Specialist 1992 1994

Reviewed non participating provider utilization requests Determined

a ppropriate decisions based on contractual benefits and medical necessity.

Monitored department updates on government regulation changes

Performed daily audits of pended workload and distributed accordingly

S upervised all administrative and clinical staff

Responsible for overseeing all department workload functions

M onitored daily workload for statistical purposes and determination of

s taffing needs.

Reviewed applications for open positions, interviewed candidates for open

p ositions, and performed employee annual review for merit increases.

Humana Louisville, KY

Member Service Representative 1990 1992

Assisted Sales and Account Services with employee/customer related

i ssues

Interpreted and instructed member/provider on policies, procedures, and

b enefits.

Investigated, researched/resolved claim, billing and service inquiries

Trained all new employees

A ssisted Provider Relations department with physician

r eferrals/resolution related to physician remittance advice statement,

Investigated customer complaints

H umana Louisville, KY

Accounting Control Clerk 1989 1990

Responsible for processing payment of Medicare sales representatives'

c ommissions.

Daily audit of account to ensure proper payment received, manual

c alculation of bonus payment, and processed check requests

Maintained daily log on HMO licensure reimbursement.

Education

McKendree University Louisville, KY

Bachelor of Arts : Communications with Human Resources area of special study

Webster University Louisville, KY

21 credit hours completed for MA, Human Resource Management

Professional License or Certifications

Insurance License State of Kentucky

Certified Lifestyle Coach

Corporate Wellness Implementation Certification

2014 AHIP Medicare Certification

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