Customer Service Case Manager
Resume:
ANITA MATHIS
Indianapolis, IN ***** 317-***-**** **********@***.*** LinkedIn: Anita Mathis
CAREER SUMMARY
HR Client/Benefit Claim Specialist; Short Term Disability Case Manager
Substantial experience and outstanding skills in customer service; Accustomed to working in fast-paced environments; Excellent interpersonal skills, ability to work well with others; Analyze and administer various components of the employee benefits compensation programs; Knowledgeable and dedicated team player with outgoing, positive demeanor and proven skills in establishing rapport with clients and contributing to company success.
SKILLS & CORE STRENGTHS
Time Management Skills
Team Leadership
Training & Development
Program Development
Analytical Skills
Complaint handling and resolution
Claims Processing
Investigative Skills
Customer Service
Quality Audits
Database Administration
Multi-Tasking Skills
Organizational Skills
Data Entry & Reporting
Short Term Disability/FMLA
Health, Dental and Life Insurance Benefits
Benefit Calculations
Flexible Spending Account
Health Reimbursement Arrangement (HRA)
Payroll
HIPAA Laws & Regulations
Strong interpersonal and communication skills
Microsoft Office Suite
Medical and Life Billing
PROFESSIONAL EXPERIENCE
Labcorp / Fortrea Greenfield, IN 2018 - present
Program Specialist – Global Pharmaceutical Contract Research Organization
Conduct insurance verification benefits for patients to determine eligible for prescribed therapy.
Facilitate the prior authorization process on behalf of customers.
Assist with problem claims and perform case management.
Identify insurance and alternative funding sources per program specifications.
Work with partner distributors and pharmaceutical manufactures to request products.
Transunion verifications for annual income for assigned program guidelines and track shipments.
Perform case management to identify alternative funding sources per program specifications.
Document calls in tracking system. Handles escalate calls per guidelines and procedures.
Kohl's Plainfield, IN 2018 - 2018
HR Specialist – E-Commerce Distribution Center
Prepare recruiting materials for onsite job fairs for schedule hiring events for interviews and orientations.
Facilitates hiring events, new hire orientation and benefits orientation sessions.
Process new hire documentation, I9 E-Verify, onsite oral drug tests and background screenings.
Administer HR processes for executives and associates.
Enter payroll data and process payroll exceptions in Kronos.
HRIS in Workday, Tracks new hire, attendance, and performance.
Assists with leave of absence/ADA process and record keeping.
Supports HR initiatives (Benefit Open Enrollment, Wellness Programs, etc)
Process termination and final pay to meet state requirements.
Ascension Health Ministry Service Center, Indianapolis, IN 2013 - 2016
Disability Case Manager -Shared Services of Human Resources, supply chain, and finance to Health Ministries
Manage the day-to-day administration for STD/FML leave of absence programs.
Review and monitoring of STD/FMLA for leave request and LOA determination.
STD benefit payments, monitoring, and Return to Work processes.
Process payroll timecards and reports for calculation of payment.
Facilitate a Return-to-Work Program or transition into LTD option.
Make decisions on claims using contractual, medical, functional, and vocational analysis.
Constant prioritization of conflicting demands with extremely tight turnaround times.
Plan and organize work to the Service Level Agreement objectives are met.
Address escalated client concerns and customer service support by email and via phone.
Control costs for disability benefits and coordinate services to at-risk employees.
Security Benefit Indianapolis, IN/ Topeka, KS 2009 - 2012
Client Specialist - Third Party Administrator (TPA) Financial Security Annuity Company
Provided services for Health Retirement Arrangement (HRA) plan services.
Processed new eligibility enrollments and updated informational changes.
Adjudicate HRA 300+ claims according to client request meeting IRS and corporate standards.
Verified completeness and accuracy of all claims before submission.
Responsible for generating claims for reimbursement.
Followed up on unpaid claims and denials.
Process generated checks daily for mail submission to participants.
Maintain confidentiality with employee records and business information.
Explanation of Benefits
Indiana State Teachers Association (ISTA) Indianapolis, IN 1997 – 2009
Client Specialist – Third Party Administrator (TPA) Membership Advocator for Professional Educators
Health Retirement Arrangement (HRA)/Section 125 Client specialist – Teacher plan regulations
Verification of Benefit/ Medical and Life Billing/ Eligibility/Enrollment Specialist
Processed new eligibility enrollments and updated informational changes.
Administered and billed for group health insurance benefits - health, dental, vision and life.
Administer COBRA group health.
Adjudicate FSA claims according to client, IRS, and corporate standards.
Responsible for the evaluation, adjudication, and processing of claims for retirement plans and flexible spending (major medical, dental, vision, and prescription drug), life insurance (standard and supplemental)
Process generated and manual checks for mail submission to participants.
Served as representative and liaison between participants and HR of school corporations.
Assists employees in communicating with the TPA to ensure reasonable responses to employee concerns and accuracy in the application of policy.
EDUCATION
General Studies- Ivy Tech
Michael’s Beauty School- Certification
OPERATING SYSTEMS
Microsoft Office Suite, Zoom, Teams and Outlook
Se2, Sanders Software, Luminx, Aetna PHIMS, Oracle PeopleSoft, Workday,
Kronos, Service Now Customer Response System, Lexmark Perceptive, Salesforce and Siebel
PROFESSIONAL DEVELOPMENT
Customer Service Series 1-4
Communication Skills
Team Leadership & Development
Diversity Workshop
Organizational Skills
Money Laundry
Sigma 6 - Yellow Belt trained
COMMUNITY ORANIZATION & VOLUNTEER SERVICES
Phillips Temple CME Church / Children Church Assistant ages 3-12
Julian Center – Shelter for Women & Children
Varies Food Pantry in Indianapolis, IN
Employer sponsored committees
401k Board for employee services
Contact this candidate