Business Analyst Customer Service
Resume:
Iris P. Arnette
Durham, North Carolina 27701
********@*****.***
PROFESSIONAL EXPERIENCE
A dedicated individual that effectively communicates with customers for the purpose of education, sales and marketing, and problem resolution. Team player that manages accounts in a timely manner and exceedingly meet departmental goals. Driven individual that has many years of experience in the health insurance setting. PROFESSIONAL EXPERIENCE
Blue Cross Blue Shield of North Carolina, Durham, North Carolina 07/09-02/14
Senior Membership Professional
• Maintain membership information by processing member enrollment, additions, deletions, and/or changes on all products and systems for complex groups and /or electronic groups.
• Process/ analyze electronic files and perform periodic audits for large/complex accounts.
• Identify, document, and report system and process problems/trends. Through analysis, determines root cause and recommends possible solutions.
• Interact with Group Administrators, Producers/Consultants, AIT and Field Sales on a regular basis.
• Process Group Level work for standard and non-standard groups.
• Administer eligibility of new, existing and renewal subscribers/members based on compliance with federal/ state legislation, Insurance Department filings, Underwriting guidelines and group or individual contracts. Address issues that are complex and sensitive.
• Reconcile payments for all BCBSNC health and life groups. Ensure that canceled groups are terminated. Reverse billing errors. Research all types of billing and eligibility issues.
• Conduct quality assurance peer audits.
• Research priority requests from department management, Compliance or Fraud regarding payment history or prior interaction with a member.
• Serve as a subject matter expert in order to help less experience department employees. Blue Cross Blue Shield of North Carolina, Durham, North Carolina 04/01 – 07/09
Group Membership & Billing Specialist
• Acted as a single point of contact for internal and external customer inquiries resolving complex issues.
• Have expertise necessary to quickly and thoroughly answer questions related to the resolution of Electronic Data Transfer of membership
• Provided cross-functional support for all operational functions, which may include one-on-one training, auditing, and or root cause analysis.
• Broad Knowledge of Electronic membership processing including HIPPA 834 and 835, knowledge of customer service protocols
• Acted as a point of contact for the Group Membership Services and Group Fulfillment Center Reps
• Assisted the Business Analyst with any system upgrades and enhancements to the mainframe system and to the Electronic process for groups.
• Served as the main contact for the Electronic data loading and supported the external customers with data as it pertains to Electronic Enrollment.
• Processed all back end reports as it relates to the Electronic enrollment.
• Assisted all areas of the Member, Group and Reconciliation areas within REBO.
• Worked on Special Projects as they are assigned.
• Responsibilities included enrolling new groups, renewing existing groups and migrating existing groups to the MHS system
• Served as a team support person to the existing staff and the new hires once they come out of training.
• Provided service support to the Group Membership Service, Producer Service unit and the Field Staff.
• Worked closely with the rating and underwriting team to ensure that all paperwork received is accurate and complete.
• Assisted the Business Analyst with upgrades and enhancements to several of the mainframe systems. Duke University, Durham, North Carolina
11/88-05/97
Cashier/Customer Service Representative
• Greeted and assisted customers
• Operated multi-line telephones
• Operated cash register by entering data and handling cash flow
• Investigated problem accounts
• Performed daily inventory
EDUCATION
Durham High School – Diploma
Contact this candidate