Medicare Enrollment Specialist and Administrator
Resume:
Tiffany McNealy
Hartford, CT *****
*********@*****.***
To obtain a position where I can utilize my skills and education to benefit a company with potential for growth and advancement.
Work Experience
Sr. Medicare Enrollment Specialist
Health New England
July 2016 to
CURRENT
Process electronic and paper enrollment applications for enrollees. Maintain assigned daily reports.
Ensure quality goals are met.
Perform monthly auditing for accuracy.
Research issues as they arise.
Process 834 transaction eligibility file.
Assist with billing inquiries.
Responsible for creating and updating policy and procedures. Process CMS Transaction Reply Report for updates and enrollments. Assigned as tester for the department.
Medicare Enrollment Administrator
SS&C
September 2021-March 2025
Processed new enrollments and changes via Market Prominence. Responsible for membership updates.
Maintained department goals.
Researched issues as needed.
Worked various enrollment reports.
Operator
Live Message CT
February 2019 to August 2020
Answer incoming calls for various offices after hours. Dispatch calls to clients for service as needed.
SENIOR TRANSACTION PROCESSOR
XEROX
2015 to 2016
Process Medicaid eligibility decisions from Health Exchange portal into EMS. Research membership history to ensure efficiency.
Responsible for meeting daily production and quality goals. ELECTRONIC ELIGIBILITY ANALYST
CONNECTICARE
2012 to 2014
Processed 834 transaction eligibility files.
Set up new electronic accounts as needed in Amisys. Maintained eligibility and id card production of assigned groups. Provided research and resolution for assigned book of business. Worked with the Access Health CT (CT Exchange) issues resolution dept. Processed manual enrollment transactions for medical/rx as needed. Worked as Sales Department liaison in regards to billing /enrollment issues. Performed department BAT/UAT testing.
SENIOR ENROLLMENT SPECIALIST
CONNECTICARE
2003 to 2012
Ensured metric goals were met.
Assisted Solo Intake department (individual market) with enrollment needs. Worked as a Sales Department liaison in regards to enrollment issues. Supported the Electronic Analyst team as needed.
Responsible for department BAT/UAT testing.
Answered calls regarding eligibility/billing.
Ensured group satisfaction.
Reviewed and processed enrollment forms.
Maintained assigned reports within the department. Resolved client issues as they arose.
CUSTOMER SERVICE REPRESENTATIVE
CONNECTICARE
1999 to 2003
Researched and analyzed member and provider issues with claims. Answered calls regarding member benefits/claims.
Acted as a backup mentor to colleagues to help solve caller's issues. Education
Bachelor's in Criminal justice
POST UNIVERSITY ONLINE - Waterbury, CT
August 2021 to Present
DIPLOMA
GLASTONBURY HIGH SCHOOL
1989 to 1993
Skills
• Customer service (10+ years)
• Data entry (10+ years)
• Amisys (20+ years)
• Problem solving (10+ years)
• Microsoft office (10+ years)
• Communications (10+ years)
• Microsoft Excel (10+ years)
• Microsoft Excel
• Market Prominence (5+ years)
• Receptionist (10+ years)
• User Acceptance Testing
• Auditing
• Test Cases
• Quality assurance
• Market Prominence
Assessments
Attention to Detail — Highly Proficient
May 2020
Identifying differences in materials, following instructions, and detecting details among distracting information.
Full results: Highly Proficient
Call center customer service — Completed
July 2020
Applying customer service skills in a call center setting. Full results: Completed
Additional Information
VOLUNTEER
Hartford Hurricanes Youth Football &Cheer
Scholastic Coordinator 2010-current
CentralCT Popwarner
League Secretary 2022- current
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