Customer Support Information Specialist

Paulette Bennett

*** ************ *****

Powder Springs, GA 30127 Phone: 404-***-**** Email: adwhou@r.postjobfree.com

Career Summary

•A highly motivated insurance professional with a combination of 25 years of Large Group and Small Group medical experience, with an emphasis in Group Underwriting and proficiency in risk analysis, profit evaluation, and proposal negotiation, as well as providing quality service with a highly ethical standard.

•Expertise in insurance claims analysis, with a comprehensive financial and administrative knowledge of all Medical lines of coverage – Managed Care (HMO), PPO, POS, Indemnity – and experience in rating for a variety of funding arrangements, including fully insured, self-insured with stop loss coverage, and Administrative Services Only.

•Strong background in client relations and customer support, providing quality service and promoting market profitability and membership persistency through interaction with internal and external customers, problem solving, issue analysis, process improvement and analytical team development.

•Demonstrated ability to work closely with team members, senior management, challenging benefit issues and times resolutions.

•Analyzing with progressive responsibilities in employee benefits administration of health benefits, Medicare Plan(s) A&B.

•Proficient in Excel, Work, Access, and Outlook. Typing 50 wph, Keystroke 97% accuracy.

Professional Experience

Humana Inc., Atlanta, GA 2018-2023

Financial Underwriter 1

•Assess risk and determine premium projections for employer groups with 100 – 500 employees in the Southeast region, ensuring profitability, case retention, and long-term membership growth.

•Analyze customer specific information – including claims experience, catastrophic claim activity, financial conditions, employee demographics, and prior carrier history – and evaluate case submissions for adherence to company standards and policy guidelines.

•Manage block of business for both existing clients and new business cases – meeting turnaround times and broker expectations, generating bids for formal and informal RFPs, and negotiating rates that meet client needs while supporting the company operating margin.

•Communicate detailed guidance on rating methodologies and claims evaluation for large account clients, focusing on customer needs, market trends, and underwriting best practices.

Humana Inc., Atlanta, GA 2014-2018

Underwriting Consultant

•Facilitate the smooth and timely flow of information between Underwriting and both internal and external customers, reviewing and interpreting ad hoc reports as requested, producing ongoing customer reports, and updating necessary underwriting financial databases.

•Prepare and facilitate routine training for fellow underwriters and analysts on current procedures and ongoing developments in underwriting and the healthcare industry.

Aetna Atlanta, 2001-2013

SE Small Group Underwriting

Served as key contact for acquiring access not only for new hires access, but also for our Underwriting and any other employees outside of our department that needed access to our servers to help them perform their duties. Responsible for at least 9 daily, weekly, monthly and quarterly reports for Small Group UW management. Actuary, Florida DOI and any adhoc reports for upper management. Renewal rating for small groups with 1-50 lives for Southeast.

•Prepare a new business and renewal quotes in QRS rating system for group sized 2-100, including the installation and set-up processes for all sold new business and renewal groups.

•Working knowledge of ALL Aetna small group business systems that includes CCI benefit interpretation and EBS billing system.

•Successful working relationship with both internal and external Aetna customers, that includes, Sales, ISO and Plan sponsor services as well as brokers and individual plan sponsors.

•Understands the importance and time sensitive nature during peak and/or “CRUNCH’ times defined by Aetna UW.

•Determined which files needed to be zipped or removed in order to obtain additional space to help transition from Prudential to Aetna servers.

•Worked with Aetna IT to obtain ID’s for the whole Underwriting Dept which consisted of over 60 employees.

•Extracted data from multiple databases and compiled the data into either Excel spreadsheets. Word documents or Access.

•Florida Membership report – by creating an Access queries to populate missing data, it was able to prevent the Underwriters from having to do an extra couple of days of work of having to review a larger than necessary listing.

•Quarterly Basic and Standard FL membership report – consisted of breaking out the new business direct premium earned and collect detailed membership counts by county and coordinate with an employee on the National Account level to coordinate submission.

•Monthly Case Listing – Provided missing cases for our database when uploading Underwriter names. Coordinated with Sales to meet the deadline to get the case listing back by our internal deadline.

Prudential Atlanta, 1995-2001

Business Information Specialist

Responsible for testing and installing scheduled reports and monitoring Jobtrac daily. Assisted and at times helped produce adhoc reports for Prudential Health Care (PHC) transition business. Underwriting contract for the PHC systems. Systems Security Coordinator for the PHC systems. Helped to coordinate the systems move from Prudential to Aetna. Worked closely with UWs to help and train on Excel to improve their productivity.

•Responsible for census, premium or claim report(s) for Underwriting. Determined which system was best to extract the data from depending on what data was needed and what parameters were to be used. Based on my knowledge of the PHC systems ensured the reports were accurate and enabled me to make suggestions as to alternate reports to run to ensure accuracy of the information requested.

•Placed programs into production by preparing the JCL to be Jobtrac ready. Some examples of preparation are: space, retention period, SMF codes and adding appropriate Jobtrac syntax. There were several hundred programs available for customer selection. Each program could have upwards of 30-50 parms which required manipulation. An example of this would be the JE6JU, which had 35 parms and was requested 10-15 times per week. These requests would take approximately one hour for job setup, parm modification, processing and verification of output.

•Have taken several security system classes on the necessary forms that are to be used for requesting access to the PHC/Aetna systems for current and new hire employees.

•Worked very closely with not just PHC IT but also with Aetna IT on the transition of our pc’s as well as making sure they were updated to NT, printers being setup and the massive cleanup of our servers.

Prudential Atlanta, 1992-1995

Underwriting Analyst

Assisted Southeast Small Group Underwriters by pulling files, inputting rate documentation into medical databases. Created premium and claims reports for Actuary.

•In charge of pulling requested files for 60 Underwriters.

•Created spreadsheets in order to keep record of which Underwriters requested which hard files to be pulled, when they were requested and when the files were refiled.

•Maintained the filing room on a monthly basis by removing termed group folders.

•Coordinated with third party vendor to pick up files to be stored offsite or to request for filed to be brought back onsite.

•Took detailed phone messages for management and Underwriters when they were not available.

Education

High School graduate: Atlanta West Christian Academy, Lithia Springs, GA.

Professional Competencies

In house and on hands training with Prudential, Aetna and Humana.

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