As a Health Insurance Specialist, I am responsible for verifying patient's insurance coverage and entering the correct information into our computer software. I handle government forms as well as work closely with patients medical records. I am trained to keep all records confidential and hold a HIPAA certificate that I am required to renew every year. I preform prior authorization requests and work any errors that our in our systems. I call various insurance companies to verify eligibility of coverage.
- Health Insurance Specialist at Benefit Recovery/David Grant Medical Center
- Sales Lead at Charming Charlie
7 months at this Job
- High School Diploma
• Provide sales forecasts and quotas for quarter and annual sales
• Educate and assist clients about health insurance policies
• Manage internal database with sensitive information
• Enrolled 70 new members within the first month of hire within doctor network programs
• Market new sales strategies to gain new member enrollees
• Collect premium payments and billing information
- Health Insurance Specialist at Affinity Health Plan
- Chief Administrative Assistant at Foot Locker Inc
- Financial Services Representative at New York Life Insurance Company
- Financial Services Representative at R. Garcia Income Tax
1 year, 1 month at this Job
- Bachelors of Art - Economics
Over 5 years experience working in the Healthcare Industry, including managing and selling Life, Health, Medicare/Medicaid (MAPD), MMP, DSNP, Dental, Vision, Accidental/Disability, Supplemental, Retirement and Long-Term Care insurance products and services to individuals and small businesses
• Formulates growth strategies to enhance Medicare AEP/OEP enrollment and renewals
• Develops and coordinates protection plan by calculating and quoting rates for immediate coverage action and long-term strategy implementation
• Develops strategy and base for long-term sources of clients by using referrals, occupational, social media networks and special-interest groups to compile lists of prospects
• Approaches potential clients by utilizing mailings and phone solicitation; making presentations to groups at company-sponsored gatherings; speaking publicly to community groups on a variety of insurance products and services
• Determines clients' particular needs and financial situations by scheduling fact-finding appointments; determining extent of present coverage and investments; ascertaining long-term goals
• Completes coverage and underwriting by delivering policy; planning future follow-up visits and evaluations of needs
• Building and retention of book of business
- Health Insurance Specialist at healthmarkets insurance, INC
- Health Care Program Manager at CHILEX HOME HEALTHCARE SERVICES, INC
- Project/Proposal Manager at IBM Corporation
3 years, 8 months at this Job
- BS - Business Administration
Bethesda, MD Division of State Technical Assistance: State Marketplace & Insurance Programs Group Health Insurance Specialist, (GS 12, Grade 6) Jan. 2016-Nov 2018 Provide technical support to State Officers serving as intermediary between State Department of Insurance, state-based health insurance exchanges, other stakeholders, and Center for Consumer Information and Insurance Oversight (CCIIO). Collaborate with State Officers in analyzing policy / operational issues to assist states running their own health exchanges and performing exchange functions for individual market and Small Business Health Options Program (SHOP). Provide daily technical assistance to states on plan management related issues to ensure appropriate state implementation of rules and processes governing health insurance markets. * Served as liaison for State Marketplace and Insurance Programs Group (SMIPG) to foster partnerships within state-based exchanges, states, and local governments that are focused on CMS' goals and objectives. * Made recommendations on plan management data submitted by states to evaluate and assess performance to improve compliance with requirements on State-based Marketplace Annual Reporting Tool (SMART). * Triaged issues related to federal plan management activities and sought resolution. * Prepared training materials to assist State Officers in navigating certification process.
- Health Insurance Specialist at Centers for Medicare and Medicaid Services
- Health Insurance Analyst at Government of the District of Columbia, Department of Insurance
- Senior Clinical Quality Analyst at United Healthcare Group, Community & State Health Plan Quality
- Account Manager, Medicare Part C & D at Centers for Medicare and Medicaid Services
2 years, 10 months at this Job
- Master's - Health Services Management
- Bachelor's - Psychology
• Oversee member mail order accounts and interpreting financial and medical data.
• Assist Medicare customers with benefits involving various insurance policies including HMO, PPOs, POP, PFFS, MAPD, and PDP.
• Utilization of multiple databases including Argus desktop, CRM/IVR, HSS, and GCP.
• Knowledgeable of HIPPA SOP.
• Maintain and update customer data and account information.
• Responsible for counseling members towards viable medical and health options.
• Provide technical support and troubleshooting assistance for HumanaPharmacy.com.
• Knowledge of pharmaceutical drugs and medical claims.
• Assist members with enrollment of prescriptions and processing pharmacy overrides.
• Customer Satisfaction ratings of 90% or above.
- Health Insurance Specialist at Humana Insurance
- Staff member at Environment North Carolina
1 year, 6 months at this Job
- Bachelors of Science in Economics - Economics
Checking patients health insurance eligibility, billing active health insurance for patients, Completing screening on patients without health insurance and Applying for Ohio Medicaid for eligible patients
- Health Insurance Specialist at Revcare
- Home Health Aide at Clearpath Home Health and Hospice
- Housekeeper/Laundry at Hampton Inn
- Customer Service Rep at PlusONE Communications
1 year, 2 months at this Job
- Associate - Medical Billing and Coding
- Certified Home Health Aide - Contiguous Care Giver
IPA Navigator (Access Health Program)
• Providing in-person health insurance enrollment services to potential enrollees
• Educating enrollees on, Qualified Health Plans, Medicaid, & Insurance Affordability Programs
• Assisting enrollees with complaints or questions regarding their health coverage
• Traveling to off-site locations to offer personalized enrollment and building strong work relationships
• Ensuring the documentation of all client data is entered accurately and promptly into the navigator's database
- Health Insurance Specialist at Joseph P. Addabbo
- Physical Therapy Aide at Action Sports and Pain Management
- Assistant Coordinator at Sound Minds Consulting
- Physical Therapy Aide at Brownsville Community Development
6 years, 2 months at this Job
- Bachelor of Science - Health Science
- Associate of Applied Science - Applied Science
• Present HealthMarkets insurance products BlueCross BlueShield, United HealthCare working through the federal health exchange.
• Present supplemental insurance products, that pays money directly to our customers
• Recruit incoming agents, to sign up and join HealthMarkets
• Cold Calling potential prospects
• Manage customers health insurance and setting up a customized program
• Work with Native Americans in the Federal Health Exchange
- Health Insurance Specialist at HealthMarkets
- United Healthcare Presentation Specialist at Maxim Healthcare Services
- Sales Representative at United Laboratories
- Sales Consultant at Lubrication Engineers
2 months at this Job
- BA - Organizational Leadership
- - Chemistry
- Associates of Science
Support Mass Health (Massachusetts); Medicaid and Medicare Buy-In members.(Inbound and Outbound calls) Billing and health insurance claims processing of Beneficiary, Providers, Health Maintenance Organization (HMO). Checking Co-Insurance, Co-pays, Fee-For-Service. Deliver excellent bilingual customer service experience to insured recipients of all ages. In depth knowledge of HIPAA rules and regulations to protect the health insurance information of clients. Use of MMIS (Medicaid Management Information System) to carry out the following tasks: Check Medicaid ID #s and coverage status. Check for submitted PA(Prior Authorizations) for prescription medications, PCA (Personal Care Attendants) and DMEs (Durable Medical Equipments). Order Medicaid recipients ID cards to members. Check for LTC (Long Term Care) recipients and status. Enroll members into health plans with their chosen health providers. PCC Plan (Primary Care Clinician Plan). Check for TPL (Third Party Liability) coverage. Managed care enrollment; MCO & ACO; (Managed Care Organisation & Accountable Care Organisation roles. Use of OPTUM Health system to enroll members, check eligibility maintain information in such areas as provider enrollment; client eligibility, benefit package maintenance; managed care enrollment and claims processing. Knowledge of member's copay, Fee For Service, health premium deductibles and limited coverage using Safety Net.
- Health Insurance Specialist at Panther Group, Maynard, MA onsite in Virginia with contract employer
- Entry Level Insurance Associate at Neighborhood Health Plan (NHP)
- Health Insurance Representative at Humana
- Tech Support Analyst at Orange Telecommunications
1 year, 7 months at this Job
- Diploma - Oracle Database Management Course
- Higher National Diploma - Computer Science
- Microsoft Certified Professional - MSQL
- National Diploma - (OND), Mass Communications
- High School Diploma - Science
Responsibilities: Assist in the sale and retention of health insurance policies to both individuals and families as well as small and large businesses. Handle day to day business for clientele. Develop promotional materials and letters. Assist with department special projects and requests. Assist in keeping up to date on information for carrier and governmental policies and the ACA (Affordable Care Act). Provide exceptional customer service. Assist clients with modifications of their plans, medical claims, and pre-approvals. Email correspondence with clients and providers regarding policies. Respond to customer inquiries and concerns. Explain health insurance benefits to clients. Screening phone calls. Email correspondence with clients and providers regarding policies. Renewal process from beginning to end for clientele. Assist in execution of benefit booklets for larger clients. Maintain and update customer databases. Create detailed health benefit spreadsheets in Excel for customers explaining plan benefits and rates. Update internal census for new and existing clients. Assist in client retention with a high degree of accuracy.
- Health Insurance Specialist at Minto & Wilkie Insurance Company
- Administrative Assistant at Equity Lifestyle Properties/Contempo Marin
- Customer Service Representative at Farmers Insurance
- Senior Sales Assistant at Sonoma Promotional Solutions
5 years, 4 months at this Job
- - Business Administration
- High School Diploma