Human Resources Professional

Elese Mason

Cell: 414-***-**** Email: *****.*****@*****.***

CAREER SUMMARY

Skilled at learning new concepts quickly, working well under pressure, and communicating ideas clearly and effectively. Strong Customer Service acumen

Ability to manage multiple priorities and work well with minimal direction

Familiarity with HRIS and Applicant Tracking systems.

Demonstrate exceptional time management, interpersonal and written skills.

Accelerated learner, demonstrated leadership skills, and served as a mentor

Bachelor’s Degree – Major: Human Resources Management, Concordia University, Mequon, WI. December 2016.

Human Resources Management

Compensation

Training and Development

Managing Change

Labor Relations/Employment Law

Workplace Safety

PROFESSIONAL EXPERIENCE

Elevance Health; Milwaukee, WI

Subrogation Examiner, October 2018 – Present

Responsible for researching and examining routine health claims that may be related to Third Party Liability, Workers' Compensation, and other subrogation/reimbursement recovery cases.

Initiates calls to groups, insurance companies, attorneys, members, and others as necessary to determine if claims have potential for reimbursement from another party.

Responds to inquiries regarding information on injury claims.

Utilizes various research methods and vendor systems to gather information.

Works with subrogation staff, other departments, and outside clients to assist with the recovery process.

Reviews diagnostic and procedure codes to determine claims relevant to each case.

Reviews internal systems/applications for various information needs.

Assists with small scale special projects.

Elevance Health; Milwaukee, WI

Customer Care Representative II, October 2017 – October 2018

Responsible for responding to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.

Analyzes problems and provides information/solutions.

Operates a PC/image station to obtain and extract information, documents information, activities, and changes in the database.

Thoroughly documents inquiry outcomes for accurate tracking and analysis.

Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Researches and analyzes data to address operational challenges and customer service issues.

Provides external and internal customers with requested information.

United Health Group; Milwaukee, WI

Member Advocate Associate, January 2015 – December 2016

Facilitate the provision of enrollee benefits with members or providers via New Member Outreach calls both inbound and outbound.

Conduct new member outreach calls and mailings, to conduct Health Risk Assessments, educate members on their benefits, ensure they have a primary care physician, and refer them to programs and services, as needed.

Management of the inbound SSI and Temporary Assistance for Needy Families (TANF) inbound hotline to ensure HRA’s for all members calling in to complete the assessment.

Participate in external community events and member education initiatives as needed.

United Health Group; Milwaukee, WI

Clinical Administrative Coordinator, March 2012 – January 2015

Possesses a high degree of professionalism with the ability to multitask and manage multiple projects at the same time.

Coordinate services with health facilities and providers.

Coordinate monthly staff meetings.

Process mail merges for Case Management mailing requests using MS Access.

Triage complete authorization requests to the appropriate Nurse Case Manager.

Stores member related documents into electronic filing system.

Provide support/answer Provider as well as member’s questions regarding status of notifications.

Maintains confidentiality and adheres to HIPAA requirements.

Manage Case Manager home visit schedules using MS Outlook.

Work in a busy, highly structured environment, handling a very high volume of inbound customer calls and cases daily.

Educate a diverse member population on wellness programs and benefits available to them, helping them connect with needed care resources via phone.

Collect case preparation documentation, authorizations, referrals and status updates from clinicians and providers, and provide necessary information to Case Managers.

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