SYLVIA FORD

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DETAIL-DRIVEN INSURANCE ANALYST

Offer excellent analytical, research and leadership skills, with focus and determination to obtain most effective results.

Extensive knowledge of SERFF, NILS, ACLI, Compliance, COBRA, regulatory reviews, and policy drafting. Conduct thorough investigations in deadline-driven situations, performing well in fast-paced, highly regulated environments. Comfortable communicating with all levels of the organizations, external partners, and customers.

Areas of expertise:

Multi-state Laws & Regulations Staff Training & Development Database Management Records Maintenance COBRA Investigations & Analysis Client Communication & Problem Resolution Claims Processing

PROFESSIONAL EXPERIENCE

UNITED HEALTHCARE GROUP 03/20/2023 – 8/31/2023

TEMPORARY EMPLOYEE

• Drafted and submitted via SERFF for approval of life and health policy forms and application to various states.

ADVANCED PERSONNEL RESOURCES, Greensboro, NC 02/2022 – 03/2023 GPA/Data Entry Analyst/Temporary Employee

• Enter various insurance company information,

• Resolving system edits.

LINCARE, Columbia, SC 01/21/2021 – 11/12/2021

Document Review Clerk

• Responsible for the quality review of all pertinent customer information for accuracy and completeness in order to meet payer requirements for timely and maximum reimbursement.

• Evaluate all received documents to ensure that appropriate information has been obtained to allow for successful Accounts Receivable.

• Maintain Held Sales by assisting customer service representatives weekly in correcting problems so billing may begin or continue.

• Responsible for reviewing various reports for quality assurance.

• Record all activity relating to the account in tickler files. SYLVIA FORD PAGE TWO

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COMPANION LIFE INSURANCE CO. Columbia, SC 07/05/2016 – 4/15/2020 Contract Compliance Specialist III

• Contribute to the development of life and health products particularly related to relevant policy language.

• Monitor state’s bulletins for possible impact on existing policy language; develop and implement enhancements.

• Prepare product filing of policy, certificate, amendments and related forms.

• Review objections and research any citation noted for preparation of the response.

• Review advertisement.

• Participate in for various market conduct exams. HUMANA INSURANCE COMPANY, Lancaster, SC 11/2005 – 01/2015 Compliance Analyst

• Submitted new products for approval for multiple states, meeting project deadlines consistently.

• Cultivated effective working relationship with state and federal regulators.

• Prepared and submitted state required regulatory reports, verifying company compliant with state requirements, avoiding unnecessary fines.

• Researched and analyzed new state laws and regulations; produced summaries and / or action plans for updated regulations, ensuring new requirements applied.

• Selected as trainer for compliance analysts and troubleshooter for electronic filing system and System for Electronic Rate and Form Filings (SERFF); assisted new hires in understanding compliance policies and procedures.

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY, Columbia, SC 07/2002 – 10/2005 Contract Analyst

• Drafted and submitted via SERFF for approval of life and health policy forms and application to various states.

• Reviewed all forms of advertisements.

• Assessed new laws for compliance impact.

• Helped draft health and life products for various states filings, ensuring company remained current on all industry trends.

• Trained all compliance analysts to use SERFF filing system. SOUTH CAROLINA DEPARTMENT OF INSURANCE, Columbia, SC 02/1998 – 07/2002 Regulatory Compliance Analyst

• Reviewed and analyzed group and individual life, accident, and health insurance policies filed for use.

• Communicated orally and written with insurance personnel.

• Performed market conduct exams, verifying insurance companies were abiding by state laws and regulations.

Insurance Regulatory Analyst

• Evaluated companies’ responses ascertaining position was compliant with insurance laws and regulations.

• Conducted interviews with consumers and company representatives.

• Reviewed consumer complaints and inquiries, presenting sound arguments on behalf of consumer.

• Assisted in public outreach and education for senior citizens regarding available Medicare options. SYLVIA FORD PAGE THREE

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EQUITABLE LIFE ASSURANCE/CIGNA, Charlotte, NC 6/1979 – 3/1998 Claims Auditor/Coverage Analyst

• Reviewed processed claims for financial accuracy.

• Input of appropriate methodology and codes to establish correct adjudication according to coverage selections.

• Processed voids and refunds.

Benefit Analyst and Coach

• Processed medical, dental, vision and short-term disability claims.

• Total customer service for all designated accounts.

• Accountable for additional training needs of New Hires. EDUCATION

2-year Technical College, Practical Nursing, Central Piedmont Community College, Charlotte, NC Claims Education Program, International Claim Association Market Conduct Management Designation (MCM), Insurance Regulatory Examiners Society (IRES) TECHNICAL SKILLS

Microsoft Office Suite: Word, Excel, PowerPoint, Access, Windows, SharePoint, Outlook CRT Skills, Lotus Notes

COMMUNITY AFFILIATIONS

Volunteer, organize and attend community outreach events, feeding the hungry Volunteer, Palmetto Baptist Hospital

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