Summary
Overview
Work History
Education
Skills
Timeline
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Belkis Alsina-Bosch

North Miami Beach,FL

Summary

Experienced Client Management Lead at AvMed with a proven ability to resolve complex issues, foster strong relationships, and drive improved service delivery and customer satisfaction. Skilled in problem-solving, proactive client engagement, and ensuring compliance with insurance standards, delivering successful outcomes for high-profile accounts.


Highly analytical and adaptable professional with strong communication and teamwork skills. Recognized for strategic thinking, a results-oriented mindset, and delivering impactful member service. Eager to leverage a positive attitude and commitment to continuous growth to contribute effectively to team success.

Overview

32
32
years of professional experience

Work History

Client Management Lead, On-Site Miami-Dade County

AvMed
08.2008 - Current
  • Consultative health sales experience and excellent customer service skills to retain key self-funded large employer group.
  • Self-directed listening and relating key information to provide solutions. Coordinate escalated client communications on issues, with focused follow up via inbound phone interaction, email, or walk in.
  • Build and foster relationships with key constituents. Assist customers at all spectrums of their careers, from new hires to retirement. Support Account Manager and Sales Director. Conduct client welcome calls to key staff to establish long term strategies.
  • Lead team of four Client Service Representatives fostering mentoring team environment to support account sales retention goals.
  • Manage four Active plan designs and five Retiree plan designs, including Medicare eligible retiree plans.
  • Travel to employer's group sites to provide onsite enrollment. Assist our Sales team with other large clients when needed, such as State of FL or other ASOs.
  • Comfortable working with Human Resources Director, HR Benefits Management, MDC unions, and other elected officials to answer benefits questions and resolve issues. Build rapport with new incoming client staff.
  • Attend annual meetings at BCC District offices with our consultants and our Sales Executives.
  • Coordinate retiree education. Recommend solutions to fit specific medical needs at retirement. Review and compare benefit options and premium costs which impact financial planning post-employment. Meet with key elected officials as they retire, and track their future elected positions at local, State and Federal level.
  • Coordinate COBRA process on behalf of client, delegating internal reports and notices.
  • Develop and maintain strong knowledge of client's ancillary products and varying levels of benefits within each product.
  • Stand in as Team Lead to JHS account team with my past experience in working with client as part of MDC/ Public Health Trust.
  • Continue rapport with JHS Executive offices, and County Staff assigned to work at JHS at various levels. Outreach to their CEO's office for help when other high level staff need care at JHS.
  • Attend key discussions and meetings with HR, and MDC unions at cost containment meetings to redesign benefits. For example, I attended meetings to reverse key plan exclusion. I collaborated with our Medical Director to revise draft plan language, presented key cost analysis to plan with pricing from local vendors. The change received approval from MDC Administration.
  • Actively participate in annual SBC and SPD document updates, supporting our Public Policy and Benefit Contract Specialist. Review and revise regulatory language and incorporate plan design changes. Edit and review plan language revisions after contract awards, before presenting to client for approval.
  • Work with MDC's Benefits Consultant to review legislative changes, such as updates from No Surprises Act of 2022. Review regulatory updates for ERISA/Non ERISA plans that may impact ASO Plan.
  • Follow all Board of County Commissioners agendas and meetings, reporting strategic items.
  • Plan in advance for each annual Open Enrollment. Revise annual Benefit Guides, flyers, dedicated website banners, and Open Enrollment presentations on PPT. Revise annual provider directory covers and intro pages. Coordinate closely with our external vendors and corporate communications team to edit, print, and ship material following client's meeting on compressed timeline.
  • Present PPT or Q & A session at benefit education meetings, in person and virtually. Continue year round with touch base webinars.
  • Promote launch of value products and work closely with vendors from planning to implementation.
  • Provide client communications on grievances and appeals from key issues. Attend appeal panels when invited.
  • Promote wellness initiatives and wellness events, such as Mayor's annual 5K, Mayor's Bike 305, and represent our brand at events that we sponsor. Attend public relations opportunities with members and key staff.
  • Implement new ideas that yield efficient process. Edits that I recommended for client's annual eligibility audits yielded higher accuracy in member responses and reduced dependent cancellations.
  • Work with our QA, and EDI Team to coordinate EDI files, and plan for OE files. Proactively track trends in data error. Track enrollment discrepancy reports, and test ID card process before mailing. to ensure we meet Performance Guarantees
  • Engage and participate in client's projects. I participated in client project with migration to Peoplesoft and 834 EDI file format. This required knowledge of mapping and EDI files. Actively followed and participated in QA testing process, identifying data failures with Client's project team, and concluding in March 2023. In 2024 we worked on a key project to migrate constitutional offices.
  • Model leadership skills to resolve our customer inquiries, easily navigating internal assets to escalate resolutions. Seek guidance from management as needed.
  • Follow elections and track updates on leadership changes and Mayoral appointments. Update contact information and organizational charts.
  • Proactive communications to inbound elected officials and staff to connect and engage new personnel.
  • Review BCC and PHT legislative agendas and attend meetings when tracking strategic items.
  • Follow all labor union negotiations for collective bargaining agreements. Transcribe my meeting notes for strategic communication as stated on record.
  • Track, participate and assist in Client's procurement process for health plan RFPs. Attend RFP selection committee meetings, follow scoring and contract awards, track posted communications. submit public records requests, and observe cone of silence rules at key meetings.
  • Track RFPs related to Dental, Vision, Life/Disability to observe and report updates to my management for strategic procurement process footprint.
  • Shadow similar government benefits for strategic changes. Compare benefits. Research legislative meetings from similar local groups, such as municipalities, Counties, PHT/JHS, or local school boards.
  • Lead cross-departmental and divisional workflows supporting client management. For example, I will work with Provider Contracting to initiate and track client's request to add provider to their networks.
  • Make recommendations to management for changes to products and policies.
  • Conduct research to answer questions and handle client and customer issues using multiple systems and resources.
  • Travel to client events at various offices in Miami-Dade County, attend Commissioner's district community health events such as holiday toy distributions, health fairs, and back to school gift pack giveaways. Assist in coordinating promotional items and seek management approvals for client event sponsorship.

Account Enrollment and Premium Processing/ MDC JHS

Blue Cross And Blue Shield Of Florida Inc.
01.2001 - 02.2002
  • Maintained Miami-Dade County and JHS group premium billing, and manage enrollment entries and premium posting for ASO Account of 10,000 POS members.
  • Achieved BCBSFL certification after three-month training in Jacksonville with finance and account billing principles. Monitored MDC and JHS EDI file process, and posted retro data changes.
  • Updated annual group premiums and ASO fee changes, and monthly posting of premiums to reconcile group invoices.
  • Audited and validated MDC and JHS member eligibility to meet and exceed contractual performance guarantees for enrollment changes. Assisted with compliance with enrollment requirements. Verified income and ASO fees, posted retroactive changes and billing of all MDC and JHS premiums, and accurately reconciled and balanced group's monthly premium disbursements.
  • Communicated directly with Miami-Dade County and JHS client and representatives to resolve discrepancies in membership files. Reported membership enrollment issues to Account Manager of MDC and JHS accounts. Actively participated in annual benefit enrollment meetings, travelling to sites for all divisions of Miami Dade County and PHT/JHS.
  • Resolved problems with high-profile customers to maintain relationships and increase return customer base.
  • Collaborated with upper management to implement continuous improvements and exceed team goals.

MDC On Site Personal Service Representative

Blue Cross Blue Shield Of Florida Inc.
08.1995 - 01.2001
  • On-site service representative at Miami-Dade County's Group Insurance Division.
  • Provided client support and member services to MDC and JHS group employees. Supported other municipalities and State judges that were offered MDC benefits through inter-local agreements.
  • Responded to key escalated issues from HR management.
  • Cultivated customer loyalty to brand's Self Funded POS Plan, promoted repeat enrollment, and improved sales.
  • Built relationships with customers who serve and reside in our community, to establish long-term business growth.
  • Provided excellent customer service to members, and key executives. Earned recognitions as high performer with excellent customer experiences.
  • Worked independently through written and telephone contact with my management. Responsible for professional interaction on site with employees, and HR representatives in a visible office setting.
  • Motivated member service associates to exceed expectations in servicing MDC and JHS members.
  • Targeted open enrollment and sales initiatives to increase enrollment of new hires and during annual open enrollment in cafeteria plan.
  • Managed high volume of key executive enrollments, and State Judges.
  • Participating in renewal of contract to support management and marketing as needed.
  • Monitored and coordinated manual enrollment applications prior to EDI file process. Trained to input and manage enrollment data for urgent cases.
  • Provided primary customer support to County's main Benefits office, and to department level HR staff.
  • Accountable for mediating benefit and claims issues, including formal written complaints assigned to me for resolution.
  • Adhered to high quality assurance requirements.
  • Reported and discussed weekly status updates to clients on high level issues.
  • Administered Cobra notification process on behalf of clients. Processed initial and qualifying event Cobra notices to qualified beneficiaries. Completed annual Cobra Compliance Seminars on group's behalf.
  • Manage internal premium reports for LOA deductions.
  • Motivated others by presenting brand's general health and wellness information in monthly information meetings at client's request.
  • Participated in annual benefit enrollment meetings and Q&A sessions for Miami Dade County and the Public Health Trust/JHS for the only POS/Self-Funded Plan offered.
  • Managed municipalities and State Judges enrollment remotely.
  • Tracked legislative BCC agendas, seeking key information on proposed benefit changes, tracking key items during RFP process. Reported on initiatives to amend County's Charter from County Manager to strong mayor form of government.

Senior Customer Service Representative, MDC

Blue Cross And Blue Shield Of Florida Inc.
11.1994 - 07.1995
  • Delivered successful customer service key government account in MDC and JHS dedicated service unit, flagship self-supporting unit consisting of claims examiners, inbound call center, and enrollment processing.
  • Assisted management in analyzing service outcomes in relation to client executives with accurate benefit and claims resolutions.
  • Attained knowledge of provider coding and provider PPO pricing models in order to accurately resolve claims issues and adjustments. Reconciled enrollment system processes in membership and account billing transactions.
  • Watched flagged customer accounts to monitor ongoing issues and deploy newfound solutions for outstanding issues.
  • Used consistent strategies to meet and exceed performance goals.
  • Engaged clients in person and over phone to answer questions and address complaints.
  • Completed inbound calls each day to meet and exceed quarterly performance guarantees.
  • Maintained in-depth understanding of health insurance to offer knowledgeable and educated responses to diverse customer questions.
  • Coordinated customer service responses for high-value customers with complex issues as leading representative in team.
  • Attended on site Open Enrollment meetings with Account Management.
  • Resolved customer service issues using company processes and policies and provided updates to customers.
  • Trained and directed new employees in call script use, conflict resolution, and data entry practices to boost customer satisfaction ratings.

Customer Service Representative/Provider Services Representative

BCBSFL/Health Options
03.1993 - 11.1994
  • Coordinated customer service to providers in dedicated service unit. Resolved claims, enrollment and fee schedule discrepancies in high paced call center.
  • Assisted with verification of benefits for HMO, PPO and other lines of business. Analyzed calculations of claims discrepancies or finalized adjudication of outstanding claims.
  • Assigned as dedicated provider service associate for key Memorial hospital system, under direction of Provider Relations team. I attended and documented notes from provider relations workshops at monthly on site meetings at hospital.
  • Calculated provider fee schedules and cost estimates under HMO and PPO contracts. Assisted provider relations improvement initiatives to improve provider services.
  • Responsible for resolving customer related telephone, walk in and written inquiries, including Medicare members, PPO and HMO accounts.
  • Answered customer telephone calls promptly to avoid on-hold wait times, and exceeded call stats for quality.
  • Promoted to dedicated Provider Service Unit. with claims knowledge and professionalism managing complex provider issues.

Education

Associate of Arts -

Miami Dade College
Miami, FL

Licensed Florida 240 Agent

Associate of Science - Court Reporting

Key College of Court Reporting
Dania Beach, FL
2008

Skills

  • Effective Problem Analysis
  • Customer Relationship Development
  • Teamwork and collaboration
  • Problem-solving
  • Customer service
  • Comply with insurance standards and regulations

Timeline

Client Management Lead, On-Site Miami-Dade County

AvMed
08.2008 - Current

Account Enrollment and Premium Processing/ MDC JHS

Blue Cross And Blue Shield Of Florida Inc.
01.2001 - 02.2002

MDC On Site Personal Service Representative

Blue Cross Blue Shield Of Florida Inc.
08.1995 - 01.2001

Senior Customer Service Representative, MDC

Blue Cross And Blue Shield Of Florida Inc.
11.1994 - 07.1995

Customer Service Representative/Provider Services Representative

BCBSFL/Health Options
03.1993 - 11.1994

Associate of Arts -

Miami Dade College

Licensed Florida 240 Agent

Associate of Science - Court Reporting

Key College of Court Reporting

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Belkis Alsina-Bosch