Candice S.

Experience

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  Giant Food

  Jun 2007 - Jul 2010

  Customer Service Desk Associate

  • Manage routine paperwork and phone calls regarding the store• Cashier• Handle Western Union transactions and bills• In charge of Uscan• Assist customers

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  Hallowell and Simmons Elementary School Before and After Care program

  Sept 2008 - Jan 2010

  Assistant Supervisor

  • Supervise and assist students as they complete activities and accomplish homework • Manage routine paperwork and handle parent and employee questions regarding the program

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  Hallowell Elementary School

  Jan 2010 - Mar 2014

  Assistant Teacher

  • Promote student writing by teaching the writing process and providing varied writing assignments that are assessed on content and organization• Introduce numbers and follow the mathematics curriculum• Adhere to school guidelines and teacher procedures to maintain regular classroom routine• Employ a proactive approach to classroom management to keep class running smoothly • Differentiated instruction for various levels of students within the classroom

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  Blair Mill and Simmons Elementary School Summer Camp

  Jun 2010 - Aug 2013

  Supervisor

  • Create and implement lesson plans for kindergarten and first grade campers• Supervise and assist students in activities, such as arts and crafts, gym activities, and free play

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  Health Advocate

  Mar 2014 - Jul 2016

  Triage Customer Service Associate

  Handle calls in all Triage queues, as well as assisting national/specialty/biometric queues when assigned by management .Assist members' incoming calls regarding their healthcare questions and other inquiries.Verify/Collect demographics and update as necessary in MemphisPinpoint and follow through with the best resolution to assist the member based on their needs or requestsTransfer caller to appropriate area(s) both internally and externallyManage tasks with timely follow-up per policies, which involve interaction with members, providers, insurance carriers and other vendorsMentor & train new hire staff Show less

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  USI Insurance Services

  Jul 2016 - Oct 2016

  Associate Account Manager

  • Expected to be well versed on all compliance topics including, but not limited to: ERISA, COBRA, FMLA, 5500s and Health Care Reform• Request, review, coordinate updates and track client plan documents such as booklets, contracts, SPDs, etc• Responsible for managing all implementation contracts when a change in carrier occurs or when a new product is implemented• Timely handling of supply requests from clients in preparation for open enrollment and new hire communication• Assist in the preparation of client communication materials including benefit summaries, PowerPoint presentations and any other communication materials that may be needed • Attending benefits or open enrollment fairs to answer employee questions and distribute benefit materials • Provide resolution support and oversight of employee issues such as enrollment and billing concerns• Escalated USI benefits center issues as needed to resolve claims inquiries Show less

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  Health Advocate

  Nov 2016 - Oct 2018

  • Train new employees’ on boarding with Health Advocate. The concentration for the three week New Hire course includes Customer Service, iClue, MemPHIS, Health Insurance and Medicare• Design curriculum for updating policies and procedures for the call center staff• Create and lead ongoing courses to educate and continue individual growth of the current staff o Benefits 201 Course focusing on Health Insurance, Plan Documents and Medicare o Client Specific training comprised of the group’s benefit offerings and ancillary products • Utilize Word, Articulate, PowerPoint, and Outlook for classes and materials• Maintain professional interactions with the call center, Human Resources, supervisors and managers • Assist the Client Services team with the implementation of new clients o Upload benefits materials for the call center into iClue and MemPHISo Create member website platforms Show less • Handle calls in all Triage queues, as well as assisting National/Specialty/Biometric queues • Address requests sent to Answers Email and after-hours calls, also working Delegate Box cases as assigned by Triage supervisors • Consistently exceeding 33 minimum calls per day expectation• Review information in the iCLUE system to utilize the member and organization details • Communicate with insurance carriers and providers upon request (i.e. medical record collection, insurance information) • Manage tasks with timely follow-up per policies, which involve interaction with members, providers, insurance carriers and other vendors Show less

  • Corporate Trainer

    Aug 2017 - Oct 2018

  • Senior Triage Customer Care Associate

    May 2017 - Aug 2017

  • Triage Customer Care Associate

    Nov 2016 - Apr 2017
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  Aetna, a CVS Health Company

  Oct 2018 - now

  • Member materials QA lead for both renewing and new group customers: Coordinate and complete the QA/review process of all CMS-required member materials, including ANOC/EOC/SOC, formulary guide, pharmacy directory, summary of benefits, LIS riders and management/oversight of the team during proof review process• SSI MDU submission process: Monitoring the timelines, getting input from Sales on status, creating Plan Extract Reports and submitting them, and reviewing/approving MDUs• Support annual Plan Build Process by reviewing and approving custom plans• Review and approve MAPD batches and plan lineage mapping for EGWP Member Materials• ID card reviews for AMRx plans to ensure client intent• ANOC/EOC: SME language review of templates and review of custom documents. Product project lead for SSI EGWPs (including AMRx). Needed to be knowledgeable of CMS guidance on Part D member materials and group-specific nuances• NY Mandate materials lead: Annual state filings with NY DFS, coordination of mailing/distribution of annual member SPD, and engaging account managers to track and document client receipt of the SPDs. Also, research/review of new regulations, operational feasibility/readiness, and annual settlement process Show less •Train Medicare Plan Services employees within Aetna’s Medicare Service Operations on the HMOe, IDX and NextGen platforms.o Complete requested trainings submitted by managers in the Enrollment, Billing and Reconciliation, Individual and Group departments o Support individual staff growth in their specific job functions to successfully maneuver multiple systems and platforms while adhering to Medicare regulationso Instruct MARx, Introduction to Medicare, CMS Chapters 2 and 3 and Aetna Medicare Products•Responsible for the creation of each agenda and schedule per training request that is assigned •Network with managers from other states to attend Business Partner, MPS A/R Functionals and L& P Meetings every month to discuss regulatory compliance matters•Lead and participate in projects approved by our manager to update MPS curriculum to maintain compliance throughout the year Show less

  • Manager, Project Mgt

    Dec 2021 - now

  • Product Consultant

    Jul 2020 - Dec 2021

  • MPS Trainer

    Oct 2018 - Jul 2020