Casandra Richardson
Katy,TX
Summary
Accomplished leadership professional with a proven track record, excelling in case management and fostering collaborative relationships. Expert in insurance and benefits administration and a motivated mentor, consistently achieving high customer satisfaction and team performance improvements. Demonstrates effective delegation and project management, enhancing operational efficiency.
Overview
12
12
years of professional experience
Work History
Sr. Employee Support Advocate
Melita Group
San Jose, CA
11.2022 - 06.2024
- Provided expert timely, accurate and friendly assistance to employees, providers, clients and vendors via phone and email regarding healthcare benefits
- Managed lengthy, sometimes complex benefits inquiries from start to finish, while also keeping employees informed on status
- Effectively utilized advanced internal and external cloud-based software systems to support our clients and track work activities
- Adhered to customer satisfaction survey criteria, with an emphasis on proactive customer service, time management and effective communications
- Oversaw case allocation amongst team, ensuring delegation to team supports meeting Service Level client agreement
- Provided coaching, guidance and mentorship on case handling
Disability Case Manager
Elevance Health
Houston, TX
02.2022 - 11.2022
- Managed caseload and evaluated eligibility for FMLA and STD benefits
- Responded to emails and voicemails from employees and physicians
- Researched and reviewed claims against disability policy coverage and duration guidelines to adjudicate the claim
- Worked with Disability Case Management Nurses to review complex claims
- Knowledge of ERISA, privacy regulations, and state and federal laws
- Administered disability income payments and offsets for State Disability payments
Disability Case Manager
ReedGroup
The Woodlands, TX
11.2019 - 02.2022
- Managed caseload/evaluated eligibility for employees eligible for ADA, FMLA and STD benefits
- Acted as a Subject Matter Expert for client-specific absence plans
- Researched to gain necessary information relevant to case management
- Entered and managed time off for Continuous and Intermittent Leaves
- Managed productivity and quality standards
- Effectively communicated with Client Managers and Account Executives
Team Manager/Sr. Health Pro Specialist/Team Lead
Alight Solutions
The Woodlands, TX
01.2016 - 06.2019
- Managed a team of Health Pro Specialists
- Trained and mentored Health Pro Specialists in business practices and processes
- Acted as liaison and collaborate with internal departments
- Facilitated presentations, meetings and huddles
- Identified gaps in training and found creative approaches for learners experiencing difficulty
- Monitored performance metrics and coached Health Pro Specialists to foster growth and career progression and rewarded great performance
- Fostered positive work environment that supported employee growth and development
- Collaborated with other departments to achieve company goals and objectives
- Conducted regular performance evaluations for team members
- Managed daily operations of team, ensuring efficiency and productivity
- Delegated tasks to team members based on their skills and abilities
- Ensured compliance with company policies, procedures, and regulations by all team members
Member Service Representative II
KelseyCare Advantage
Pearland, TX
07.2012 - 12.2015
- Provided Concierge Service to members which include a high level of customer service to callers
- Assisted walk-in Medicare clients with benefits inquiries
- Acted as a knowledge resource for all items related to claims and/or access-to-care issues
- Reviewed and reconciled claims issues; assist with claims review/audits for accuracy, adjustments, balance billing, payment negotiations and appeals
- Effectively communicated with clients and client contacts within departmental guidelines
- Collected pertinent information from members and providers to assist in resolving the issue
Education
Certification - Business
Texas School of Business
Houston, TexasSkills
- Strong, Professional Leader
- Effective Delegation
- Motivated Coach and Mentor
- Subject Matter Expert
- Patient Relations
- Benefits Administration
- Business Office Administration
- Facilitate Collaborative Relationships
- Project Management
- Escalation and Resolution Specialist
- Creative Team Building
- Engaging Trainer
- Resource Management
- Teamwork
- Insurance: Medicaid, Medicare, Commercial-Appointments, Authorizations, Claims, Eligibility, Referrals, and Verification
- Quality Evaluation
- Survey Management
- Case Management
- Process Improvement
SYSTEMS
- ADP
- ALICS
- Citrix
- CRM
- Epic
- Microsoft Suite
- Nice
- Paycor
- Paylocity
- PeopleSoft
- Rippling
- Salesforce
- Workday
Timeline
Sr. Employee Support Advocate
Melita Group
11.2022 - 06.2024
Disability Case Manager
Elevance Health
02.2022 - 11.2022
Disability Case Manager
ReedGroup
11.2019 - 02.2022
Team Manager/Sr. Health Pro Specialist/Team Lead
Alight Solutions
01.2016 - 06.2019
Member Service Representative II
KelseyCare Advantage
07.2012 - 12.2015
Certification - Business
Texas School of Business
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