Customer Service Term Disability

adytfo@r.postjobfree.com AMANDA YANEZ Phoenix, AZ 602-***-****

EDUCATION Grand Canyon University

Bachelor of Science- Business Administration

Expected Graduation: 2027

Glendale Community College

Associates- Applied Sciences

EXPERIENCE

June 2021- June 2023 Universal Technical Institute- Avondale, AZ

Campus Admissions Manager

Manages and motivated a team of 4, to ensure goals are met through mentoring, advising, counseling, and communication aiming to increase enrollment and decrease withdrawal ratio.

Interfaces with students to determine goals and motivations by using a consultative sales approach that includes open-ended questions and active listening while effectively delivering the base curriculum for all programs offered at Universal Technical Institute to prospective students.

Participates in campus events and proactively establishes relationships with campus president,, student help department directors, Human Resource Partners, and VPs to ensure that Department of Education compliance was followed and executed.

Conducts daily touring of prospective students to address issues or concerns regarding cost, financing, dress code, curriculum, tutoring, testing procedures, enrollment paperwork information, cancellation policy, or other related items to ensure student understands the entire enrollment process.

Complied with FERPA (Family Educational Rights and Privacy Act) to ensure this was followed for every student to maintain privacy of personal information to outside entities.

July 2018- June 2021 Swift Transportation- Phoenix, AZ

Benefits Coordinator

Worked closely with benefits manager and director in administering benefit programs, providing benefit awareness, and coordinating benefit enrollment and projects.

Assisted 21,000+ Swift/Knight employees with benefit questions, handling of benefits exceptions, and provide problem resolution regarding eligibility and coverage.

Act as liaison between vendors and employees when benefit exceptions occur, or project communication is required.

Process leaves of absence and qualified medical child support orders in alignment with Federal, State and company guidelines.

In conjunction with the Director of benefits to streamline the benefit process in developing and implementing continuous improvements to the benefits process within strict accordance of company guidelines.

Responsible for assisting benefits manager and director with open enrollment, enrollment testing and benefit website audit.

Nov 2016- July 2018 CIGNA Group Insurance- Phoenix, AZ

Care Advocate

Process short term disability, long term disability, family medical leave and paid family leave claims.

Administer benefits and payments as needed appropriately for claims. Assisted the claims managers with claims audits, verification of benefits and correct ICD-10 (International Classification of Diseases) codes to approve, deny or pend open claims.

Explain short term disability, long term disability, family medical leave and paid family leave policies to members, based on employer administered policies.

Update claim status and update information received by provider to administer benefits timely and correctly.

Sept 2014- Nov 2016 Tricare/United Healthcare- Phoenix, AZ

Referral Coordinator

Review incoming referral requests from civilian providers and military bases.

Certify eligibility of an Active-Duty Service Member or beneficiary to apply proper benefits.

Build referrals for providers based on information received from military bases.

Process and review ICD-10 (International Classification of Diseases) codes as providers requests.

Approve, Deny, or escalate referrals for further review based on services requested, service codes, or diagnosis indicated.

Executed daily goals range from 130-200% efficiency with processed requests as 100% quality.

Mar 2013- Sept 2014 CIGNA Leave Solutions- Phoenix, AZ

Short Term Disability Lead

Gather intake for family medical leave and short-term disability claims.

Confirm provider information and member appointments with various providers.

Aide members in acquiring proper documentation for claims received.

Process FMLA and give directions on activation of benefits, duration, and amount.

Provide benefit denial information, direction of appeal and next steps.

Approve or deny short term disability benefits based on employer benefit policy.

Provide benefit amount to be paid for short term disability, frequency, and duration of approval.

Apr 2006- Mar 2013 CIGNA Voluntary

First Call Resolution Lead

Educate customer service representatives with answers to any benefit or claims questions.

Receive and resolve escalated supervisor calls from members or providers.

Process past due claims for resolution.

Review HCFA’s, 1500’s, EOB’s, SPD’s, SAR’s for benefit information and processing errors.

Abide by PHI guidelines when speaking with providers or members.

Advise customer service, members and providers of COBRA coverage and processing.

Actively support other departments with backend, overflow claims processing.

Approve timecard, overtime, and time off requests.

Provide weekly one-on-one training as well as monthly group training on policy changes.

Work with directors, VPs, and managers to ensure smooth benefit flow.

Facilitate new hire training, review policies, SOP’s and company guidelines. Educate new hires on the benefit plans offered and how to effectively recite them to members and providers over the phone.

COMPUTER SKILLS MS Word, Excel, PowerPoint, UltiPro, CRM, Skillpoint, AS400, Peopleware, EHR, Skillsoft, Peoplesoft

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