DEON ROSS
Customer Advocacy | Government Programs | Regulatory Compliance
Summary
Customer advocacy and government programs professional with over eight years of experience in supporting Medicare, Medicaid, and employer-sponsored health plan members. Expertise in navigating complex eligibility, enrollment, and appeals processes while ensuring regulatory compliance. Proven track record in simplifying program requirements and delivering customer-centered solutions through effective collaboration across departments. Committed to enhancing access to essential services through advocacy and operational excellence.
Overview
10
10
years of professional experience
Work History
Enrollment & Government Programs Specialist
Point32Health
05.2022 - Current
- Guide members through complex Medicare, Medicaid, Health Connector, and employer-sponsored enrollment processes while ensuring compliance with federal, state, and organizational regulations.
- Advocate for members by researching and resolving complex eligibility, enrollment, and benefit issues through collaboration with cross-functional teams and external partners to deliver timely, accurate solutions.
- Maintain highly accurate member records and documentation while safeguarding confidential information and ensuring compliance with CMS, HIPAA, and organizational standards.
- Support onboarding and knowledge sharing by coaching team members on operational workflows, regulatory requirements, and departmental best practices.
- Manage a high-volume workload while balancing competing priorities, maintaining exceptional accuracy, meeting productivity goals, and delivering outstanding customer service.
- Investigate enrollment and eligibility discrepancies, coordinate resolutions across departments, and ensure timely, member-focused outcomes that support continuity of coverage.
- Educate members on eligibility requirements, coverage options, appeals processes, and government-sponsored health programs, helping individuals make informed decisions and access essential healthcare benefits.
- Collaborate with internal departments by presenting operational updates, sharing reporting insights, and supporting process improvements through virtual meetings and cross-functional communication.
Medicare Member Advocate
Point32Health
04.2020 - 05.2022
- Served as a trusted advocate for Medicare Advantage and Senior Care Options (SCO) members by providing guidance on benefits, eligibility, claims, appeals, organizational determinations, and enrollment while ensuring exceptional customer service.
- Investigated complex member concerns by partnering with cross-functional departments to resolve coverage, claims, and eligibility issues while ensuring timely and accurate outcomes.
- Maintained accurate and comprehensive documentation to support regulatory compliance, operational integrity, and continuity of member care.
- Educated Medicare and Special Needs Plan (SNP/SCO) members on healthcare benefits, coverage options, appeals rights, and available community resources, empowering informed healthcare decisions.
- Built trusting relationships with seniors and vulnerable populations by explaining complex healthcare regulations in a clear, compassionate, and easy-to-understand manner.
- Guided Medicare individuals through annual election periods and qualifying enrollment events by evaluating healthcare and financial needs, explaining available plan options, and helping members make informed coverage decisions.
Patient Financial Services Specialist
ROI Healthcare Solutions (Cognizant)
07.2019 - 04.2020
- Partnered with patients to resolve billing concerns by identifying affordable payment solutions, financial assistance programs, and available healthcare resources to reduce barriers in healthcare access.
- Worked collaboratively with patients to resolve complex account issues while balancing organizational policies with compassionate customer service.
- Maintained accurate records while adhering to healthcare privacy standards and organizational requirements.
Pharmacy Technician
CVS Pharmacy
04.2018 - 07.2019
- Assisted patients with prescription services while ensuring accuracy, confidentiality, and outstanding customer care.
- Educated patients regarding prescription procedures, insurance questions, and pharmacy services.
- Collaborated with pharmacists to deliver safe, efficient patient care in a high-volume healthcare environment.
Business Office Data Entry Specialist
TransCore
06.2016 - 04.2018
- Performed high-volume data entry and record maintenance with a strong focus on accuracy and efficiency.
- Reviewed documentation and routed information to appropriate departments for processing.
- Utilized Excel and proprietary software to track records, testing results, and analyze operational data.
- Identified and reported data discrepancies to support quality assurance initiatives.
- Collaborated across departments to support operational workflows and customer service objectives.
Fulfillment Associate (Part-Time)
Amazon
10.2024 - Current
- Maintain accuracy, efficiency, and attention to detail while working within time-sensitive operational deadlines.
- Demonstrate adaptability, reliability, and strong organizational skills while balancing multiple professional responsibilities.
Education
Bachelor of Arts - General Studies, Business Administration Concentration
Southern New Hampshire University
Manchester, New Hampshire01-2026
Associate of Arts - General Studies
Quinsigamond Community College
Worcester, MA01-2017
Skills
- Customer Advocacy
- Government Programs
- Medicare & Medicaid
- Regulatory Compliance
- Member Education
- Community Outreach
- Program Administration
- Customer Service Escalation
- Cross-Functional Collaboration
- Financial Assistance Programs
- Process Improvement
- Microsoft Teams Presentations
- Data Analysis & Accuracy
- Microsoft Office Suite
Timeline
Fulfillment Associate (Part-Time)
Amazon
10.2024 - Current
Enrollment & Government Programs Specialist
Point32Health
05.2022 - Current
Medicare Member Advocate
Point32Health
04.2020 - 05.2022
Patient Financial Services Specialist
ROI Healthcare Solutions (Cognizant)
07.2019 - 04.2020
Pharmacy Technician
CVS Pharmacy
04.2018 - 07.2019
Business Office Data Entry Specialist
TransCore
06.2016 - 04.2018
Bachelor of Arts - General Studies, Business Administration Concentration
Southern New Hampshire University
Associate of Arts - General Studies
Quinsigamond Community College