Experience

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  Aetna us healthcare

  Nov 1996 - Mar 2000

  Medical claims specialist/coach

  Process medical claims according to plan provisions and plan specific contracts, maintain quality and production standards for forty employees, identify and address quality issues in order to ensure quality service to members and providers, provide on-going employee training on existing and new systems and processes, resolve escalated claims issues, complete file claim reviews for key clients.

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  Mercer

  Jun 2000 - Nov 2005

  Benefits service representative

  Responsible for incoming calls with reference to health and welfare benefit issues, claims, EOB’s, ID cards , dental and cafeteria plan inquiries, customer relations with providers and carriers including initial and subsequent contacts to ensure prompt resolution, employee relations, identify and reconcile employee problems relating to health and welfare benefits, maintain appropriate files and documentation, process of all medical support orders, complete interview process of all new hires during annual enrollment season, assist with QA testing of the web enrollment tool, IVR system and Benefits Workstation system, train employees on general benefits administration, compliance, client specific plans and benefits systems, serve as carrier main point of contact for eligibility and claims issues, process manual emergency enrollments, consult with account managers regarding unresolved service issues with customer service and eligibility departments. Show less

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  G&a partners

  Dec 2005 - Jun 2010

  Benefits specialist

  Acted as a third party benefits administrator. Managed the Benefit administration for 15-20 clients with a combined life total of 600+ lives. Duties included: employee benefit enrollments, coordination of benefit enrollment meetings for new hires and open enrollment, payroll benefit deduction set ups, process employee benefit status changes, research employee claim and eligibility issues, act as liaison between carriers and employees to resolve discrepancies, assisted employees with medical, disability and life insurance claims. Assisted the insurance brokerage department with the following: employee census, employee enrollment and insurance communication materials. Coordination of employee benefit notices such as HIPAA, COBRA, Section 125 and State laws. Respond to notifications from state agencies such as medical support orders. Maintain employee benefit files. Completed other duties as assigned. Show less

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  Intergulf corporation

  Mar 2012 - Mar 2013

  Hr generalist

  New-hire onboarding, maintain personnel folders, recruitment, records keeping, employee relations, maintain company intra-net training library, scheduled employee training refresher classes, Employment verifications, company event planning, benefit & 401k retirement saving plan administration.

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  Brunel

  Mar 2013 - Mar 2023

  Senior human resources and benefits administrator

  Responsible for new-hire on-boarding, preparing, and maintaining employee personnel files, assuring accuracy, compliance, and confidentiality, i.e.: unemployment claims, verifications of employment, medical support orders, and I9 status. Create and maintain Standard Operating Procedures (SOP), maintain HRIS system with up-to-date employee information and benefits plan designs, maintain state tax matrix, separation of employment notice templates, leave administration, EEOC reporting, process employee terminations, implemented systems to assist with automation and reduce manual HR processBenefits Administration of various employee benefit programs, such as a self-insured group medical plan dental, vision, short/long term disability, ancillary plans, life insurance, business travel plans, HSA Spending plan & 401K retirement plan. Show less

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  Usi insurance services

  Mar 2023 - now

  Senior account manager

  Manage Employee Benefit insurance accounts with complex book, various funding methods and increased level of customization, while also providing proactive and personalized day to day client support.Act as the primary contact between clients and insurance carriers.Provide insurance expertise to clients. Manage client renewals and negotiate with carriers on behalf of clients.Participate in client meetings regarding renewal and utilization results.Client contact and in-person attendance at client meetings.Engage clients, where appropriate, with internal USI Technical Resources.Educate, advise, and aid clients on all Compliance topics. Includes, but not limited to, ERISA, COBRA, FMLA, 5500s and Health Care Reform.Develop employee communications for renewal changes, enrollment procedures, miscellaneous benefit changes.Participate in peer review as both a participant and a reviewer of standards client deliverables.Conduct on-site meetings to communicate or administer benefit plans.Resolution support and oversight for client issues such as contract clarification and billingProvides benchmarking reports to client (annually, quarterly, or monthly)Manages projects in concert with the client including, but not limited to, all vendor implementations.Manages claims and coverage issue resolution for clients’ employees when elevated from HR.Facilitates preparation of open enrollment (OE) packets including SBCs and disclosure notices, when not completed by Account Administrator.Creates employee benefit booklets, when not completed by Account Administrator.Develop open enrollment presentations and conducts benefits webinars and/or records Brainshark presentations for employees and HR Managers.Perform contract review and facilitate preparation of SPD Wraps, Cafeteria and POP Plan documents.RFP process, such as proposal development including preparing census, entering, and updating pivotal information as needed, on-line quoting, and marketing a group when requested. Show less