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Click here or scroll down to respond to this candidateCandidate's Name
6 E Phoenix AveLawnside, New Jersey Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLEGoals:I am a new CDL-A truck driver trying to find a career position with a company that can assist me with the next chapter of a trucking career. I am eager to continue my learning of the trucking industry to become a better driver. EmploymentAetna Healthcare, Blue Bell PaPlan Sponsor Liaison 2016- 2023Single-point-of contact for Plan Sponsors on member-specific or broader plan administration matters Understands Life Cycle view of Medicare activities, quotes, install, eligibility, billing, administration, benefits, provider/network activity, claims (medical & RX), etc. Develops/implements a customer service strategy for each assigned Plan Sponsors/TPAs (customer fact sheets) Participates in implementation calls and site visits on Plan Sponsors' book of business serving as the Medicare Advantage Subject Matter Expert (travel as needed) Identifies business problems, obtains information and accurately defines root causes while developing a course of action for successful service solutions Initiates and maintains partnerships with others within Aetna to encourage cooperation and cross-functional activities on workflow, ideas and service solutions Ownership and accountability for the resolution of Plan Sponsors/TPA service inquiries Ownership of the Plan Sponsor Tool, CTT, and ID Card QR as well as use service tools to provide detailed membership reporting to create a snapshot of the lifecycle Works in tandem to monitor the submission of new business and renewal paperwork to ensure systems are updated and eligibility is processed in accordance with OE timeline Provide updates on issue resolution and action plans to Plan Sponsor, TPA, Sales Executives and Medicare Client Services management Acknowledges receipt of escalated service inquiries to the Plan Sponsors/Aetna Sales Team within one business day, and for issues requiring a longer resolution, follows up at set intervals Takes a proactive role in all internal/external calls by being prepared and well-versed in all subject matter related to Plan Sponsor Liaison role & responsibility. Plan Sponsor Liaison is responsible for all back-office operation conversations and researches and responds to all operational take-aways. Articulates the CMS regulatory requirements that govern Aetna Medicare Advantage Plans and demonstrates knowledge of understanding of all Aetna Medicare products and services Collaborate with the Account Team to assist with customer meetings for the State of New Jersey business. Medicare Client Service 2013- 2016 Analysis data for enrollment processing issues Collaborate with Federal Medicare on entitlement and eligibility issue State Pharmacy Assistance Program monthly reconciliation for New Jersey Trending and tracking error for call center review Root cause analysis of group members for an Evidence of Coverage Project Support the broker area Collaboration with the customer service area Identifies and communicates system issues to internal/external constituents, documents and implements necessary workflows. Understands constituents needs and priorities; demonstrates methodologies to achieve successful account management.Quality Assurance Specialist 2003-2013 Coaching and mentoring Customer Service Reps Assist in managing customer service team in Supervisor's absence Auditing customer service representative monthly for accuracy, professionalism, and workflow managing Interview potential candidate for employment Monthly Business Review Side by side coaching and silent monitoring Resolve issues that were because of a supervisor call Building better relations with customers Speaking to trainees on new systems Collaborate with Nation Quality team for effective monitoring Special Project issue which are forwarded by the Network Daily reports to upper management on special project status Work with Network Management, Provider Liaison, and Contract Negotiator to resolve provider issues and concerns Collaboration call with Aetna Behavioral Health Network Management to report any problems, new workflows, or updatesAchievements Complete Leadership Program Obtained the Yellow Belt in the Sigma Six Program Lean Certified New Jersey Accidentally, & Healthcare LicenseEducationCommunity College of PhiladelphiaReferencesFurnishedUponRequest |
