Carol Franco

Canoga Park, CA *****, adrjzz@r.postjobfree.com 818-***-****

Detail-oriented professional with Six years of Medicare knowledge. Analytical and strategic leader strongly adept in identifying requirements for client eligibility, verifying determined compliance, and reviewing case files for errors and processing needs. Demonstrated achievements in managing complex projects and initiatives, implementing training and development, focused on business performance and productivity, and using critical analysis for problem solving. Excellent customer service and teaming skills, work effectively under pressure on multiple tasks and have strong organizational skills. PROFESSIONAL EXPERIENCE

Centene/Health Net, Woodland Hills, CA 3/2015 – 5/2021 Medicare Membership/Eligibility Rep III/Auditor

• Trained new Associates on auditing AEP (Annual Enrollment Period) Enrollments, Disenrollment’s, Employer Group applications and on Medicaid qualifications and verification.

• Maintained accurate eligibility records for assigned line of business. Entered system eligibility data daily including new enrollees, changes, and cancellations.

• Audited for accuracy of applicant information thru multiple systems including MP, CMS, FileNet, and Medicaid.

• Completed and audited reports for accuracy (Employer Group Termination Report, Duplicate report, EDV (Enrollment Data Validation Reports ...etc.)

• Completed and audited Internal Compliance cases (15 various cases, examples are Voluntary Disenrollment, Incomplete Enrollment Request, Disenroll Denial, LIS Term/Update...etc.

• Called customers, requested, or verified information needed for completion of documents.

• Audited various member letters for accuracy (Reinstatement, Loss of SNP, LEP adjustment, LIS Rider, Enrollment Acknowledgement...etc.) per CMS regulations.

• Audited member information and resolved issues.

• Responsible for meeting daily quota as well as maintaining a high level of accuracy (97%), including daily auditing of all work.

• Assisted on various tasks in other departments.

MS Word/Excel/UMV/Portico/FileNet/Omni/MarketProm/AMES/Marx/Ember/AMES/SharePoint/45wpm Pratt & Whitney Rocketdyne, Canoga Park, CA 1/1989 - 4/2013 Engineering Assistant

• Provided support to the Test Operations Team Manager and 40 Engineers in the liquid propellant rocket engine program (Space Shuttle Main Engine, 106 flights/J-2x)

• Generated briefing charts for Test Readiness Reviews, Post Engine Test Data Reviews, and Hardware Acceptance Reviews, used for both internal, NASA and customer meetings

• Populated the SSME anomaly database and Test history

• Coordinated and prepared Engineering change orders, action requests in support of the engineering team to meet critical and aggressive test schedules

• Provided full admin support for the department, organized meetings, managed four conference rooms

• Served as Liaison between customers, NASA, Marshall Space Flight Center, Stennis Space Center, and Kennedy Space Flight Center

• Simultaneously managed projects ensuring quality control and procedural compliance Process Improvements: Assisted in the development and implementation of the Anomaly database, aided in data transfers between servers to NASA/MSFC, completing full transfers in one day