Manager Life Insurance

TOP-PERFORMING CLIENT RELATIONS SPECIALIST

Strong understanding of claims processing, and benefit facets configuration.

Building trust, strengthening loyalty and improving the bottom-line through attentive, knowledgeable client management; cultivating proactive partnerships with new clients and consistently meeting the needs of existing clients.

Technical Skills

Client Relationship Management

Strategic Planning & Implementation

Data Reporting & Documentation

Internal Investigations & Audits

Industry & Regulatory Compliance

Revenue Growth Strategies

Self-funded/Fully Insured Plans

Database Creation & Management

Claims Resolution

Issue Resolution & De-escalation

Team Leadership & Development

Reference Based Pricing

Facets Applications

Luminex Claims System

RIMS Claims System

System Configuration & Testing

Microsoft Office Suite (Word, Excel, PowerPoint)

PROFESSIONAL LICENSURE

General Lines Agent Life, Accident, Health, HMO – Texas Department of Insurance (August 31, 2022)

CAREER NARRATIVE & MILESTONES

Axiom-Systems – Fredericksburg, MD July 2020 – December 2020

Senior Benefit Facets Configuration Analyst for BSBSNC - Contract

Participated as a project team member assessing, configuring and auditing configuration.

Analyzed configuration across commercial lines of business.

Validated current configuration against the Policy Summary of Benefits.

Participated in the migration of 2021 project for Shell 1 and Shell 2 builds.

Benefit Configuration, specifically with Supplemental tables (BPA: SPCR/SRCR, SPCT/SRCT) and Service Definitions (SEDF).

Simplan Administrators – Plano, TX September 2018 – June 2020

Senior Account Configuration Implementation Manager/ End to End Configuration

End to end configuration for medical, dental and vision plan in the testing system and live Luminex claims paying system.

Improve build configuration and automation to efficiently manage the release of CPT/HCPCS codes.

Developed and implemented 16 insurance plans into the Luminex claims payment system reducing the time taken to build a plan from 8 hours per client per plan to 1 hour per client per plan.

Strategic plan implementation with organizational goals, policies, quality assurance, and growth objectives.

Collaborate with sales reps to guarantee the accuracy of all information for new and renewal business.

Tasked with providing HIPAA and federal ACA compliance.

Critical in preparing new and renewal submissions and proposals.

UnitedHealth Group – Dallas, TX January 2017 – September 2018

Benefit Facets Configuration Analyst

Maintained 4.8 out of 5 ratings on performance values in benefits configuration, audits, and time management for Medicare-related products.

Benefit Configuration, specifically with Supplemental tables (BPA: SPCR/SRCR, SPCT/SRCT) and Service Definitions (SEDF).

Wielded deep expertise in leading research into installation and benefits issues to develop resolutions specific to individual customers.

Analyze and interprets business requirements and system requirements.

Conducted audits into contract benefits and pricing configuration.

Participated in Claims Configurations; building and testing members.

Analyzed configuration across Medicare and Medicaid lines of business.

Pan-American Life Insurance Group – Richardson, TX November 2015 – January 2017

Implementation Manager

Improved productivity; by reducing the amount of redos by 70%.

Partnered with the actuarial team to test and utilize the Rate Setup Sheet used along with the rating engine.

Effectively communicated with the Billing Director to certify the correct accounting and CODA coding was set up for the new coverage codes.

Trained new employees on the completion of rate sheets as the Plan Documents that were sent to clients lining out the company’s benefits.

RH Administrators – Carrollton, TX September 2013 – September 2015

Client Service Account Manager

Generated more than $10,000 in savings for clients by creating the plan documents in-house as opposed to the use of external vendors

Served as the go-to subject matter expert for benefit contract interpretation and execution for self-funded plans.

Liaised between clients and the company to independently resolve all service problems.

Prepared medical benefit contracts (SBC and SPD) in compliance with ACA requirements.

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