Betty Amezcua
Healthcare
Fresno,CA
Summary
A dedicated, organized, and results-driven professional credited with combining complex assignments and improving processes to increase proficiency and productivity. Strong expertise in grasping new concepts quickly to allow for effective delegation and improved profit margins. Highly experienced and accomplished in building mutually beneficial relationships with stakeholders at all levels.
Overview
2
2
years of professional experience
Work History
Sr Analyst Plan Sponsor Liaison
CVS Caremark / Aetna
08.2021 - 04.2023
- Leads process improvement initiatives to improve productivity, accuracy for customer service team and tool development.
- Managed assigned projects and ensure project plans and work tasks are in alignment with overall organization goals.
- Evaluated complex and high visibility cases, identify risks and recommend appropriate measures to manage risks while growing or retaining membership.
- Responded to internal/external complaints; interprets and provides clarification & documentation on new policies and processes; and participate in broker/customer meetings.
- Mentored, coached and assisted with the development of training for staff; provided technical expertise critical for achieving key performance measures and finalizing cost-effective decisions relative to benefit plan administration.
- Reviewed the work of others and assisted in quality assurance initiatives.
- Collaborated cross-functionally as well as cross-departmental to achieve business goals; influences change/ enhancement to business processes, policies and system infrastructure to improve information quality, availability, and access.
- Collaborated with market leadership, sales leadership, and vendors or delegated entities to solve trending or elevated membership inquiries and escalations.
- Supported sales/market teams at member meetings.
- Oversees eligibility escalations and QuickBase and any additional support.
- Analyzed and evaluated members' eligibility and new available benefits programs and recommended to our healthcare members.
- Performed multiple functions including enrollment, billing, accounts receivable, collections, and customer service for an assigned book of business.
- Performed quality assurance on billing and enrollment transactions on an as needed basis.
- Responded to customers’ inquiries or requests, and eligibility/billing issues.
- Researched, resolved and responded to eligibility and billing inquiries generated from customer, third party vendors, Service Centers, Sales and other external parties.
- Utilized and interpreted online resources to understand customer account structure and benefits.
- Applied policy, legislation, customer account structure and benefit guidelines to eligibility decisions.
- Reviewed aging reports to coordinate collection and reconciliation activities (which included cancellation of overdue customers).
- Reviewed and audits plan sponsor member listings, other payment documentation, and corresponding payment history and determines if any discrepancy.
Education
Bachelor of Science - Business Administration And Management
California State University - Fresno
Fresno, CASkills
- Process Research
- Claims Service
- Service Delivery
- Business Development
- Claims Reporting
- Billing Procedures
- Document Organization
- Problem Resolution
- Customer Service Process Improvement
- Customer Accounts Management
- Electronic Systems
- Benefits Interpretation
- Open Enrollment
- Eligibility Determinations
- Customer Inquiries
- Inbound Calls
- Special Projects
- Verbal and Written Communication
- Continuous Improvement Process
Timeline
Sr Analyst Plan Sponsor Liaison
CVS Caremark / Aetna
08.2021 - 04.2023
Bachelor of Science - Business Administration And Management
California State University - Fresno
Similar Profiles
Katherine YoungKatherine Young
RN Care Manager at CVS Caremark-Aetna Better Health of OhioRN Care Manager at CVS Caremark-Aetna Better Health of Ohio
Timothy F. SkinnerTimothy F. Skinner
Hadoop/Big Data Application Administrator at CVS Caremark (Aetna)Hadoop/Big Data Application Administrator at CVS Caremark (Aetna)
Cheri GianakosCheri Gianakos
Senior Product Development Manager at Aetna Healthcare, a CVS Caremark Co.Senior Product Development Manager at Aetna Healthcare, a CVS Caremark Co.