DOMINIQUE Y. SIMS
Summary
Motivated and diligent business professional with a proven track record in customer service management within the communications technology industry and healthcare field. Skilled in diplomatic and tactful communication, adept at interacting with professionals and non-professionals at all levels. Demonstrated ability to quickly master a wide range of technologies, from novice to advanced skill sets. Experienced in managing sensitive internal and external client accounts. Areas of expertise include effective customer relationship management, problem-solving, and efficient project coordination.
Collaborative individual with expertise in providing exemplary service regarding benefits support. Multitasking Benefits Specialist knowledgeable in state and federal regulations and maintaining employee confidentiality.
Overview
21
21
years of professional experience
Work History
HR Benefits Representative
ProMedica Health System
03.2022 - Current
- Demonstrate a comprehensive knowledge of ProMedica's employee benefit offerings; clearly understand eligibility requirements, coverage design, employee contributions, and enrollment processes and procedures
- Serves as a resource and content expert when employees and members of leadership require assistance and act as a liaison to the insurance providers
- Manage benefit administration processes, entering information into the benefits enrollment system to meet critical deadlines for payroll and benefits enrollment
- Demonstrate working knowledge of benefits systems, employee contributions, and payroll
- Duties include monthly billing, counseling employees on benefits, responding to and initiating courses of inquiries regarding benefits, independently resolving problems whenever feasible, assists with the development, planning, and implementation of benefits-related activities such as annual open enrollment and Stop & Ask sessions
- Establishes a collaborative relationship with business unit leadership and all HR employees to ensure that organization goals and objectives
- Develop and present educational materials on benefits-related topics/issues to various audiences for orientations
- Participates and coordinates projects and analytical tasks as assigned
- Conducting orientations for providers coming into the health system
Housing Specialist Housing Choice Voucher Program
Lucas Metropolitan Housing Authority
04.2021 - 03.2022
- The primary purpose of this position is to assist the staff of the HCVP department with processing and determining applicant eligibility and continued eligibility, notify applicants of the decision rendered, and assist with providing additional services to HCVP participants
- Establishes and maintains electronic filing system and clerical takes for applicants; certifications, and interims; verifies all data changes reported by HCV participants; enters and retrieves data from this system, ensuring accuracy and completeness of information
- Prepares residents for continued eligibility through the completion of necessary documentation and recertification appointments
- Investigate fraud and prepare retroactive debts
- Review the file for the accuracy of information supplied for cancellation and make the first determination of whether a hearing will be necessary
- Submits necessary documents required for informal hearings and serves as LMHA representative during informal hearings
Provider Database Coordinator
PARAMOUNT HEALTH CARE
05.2012 - 02.2020
- Responsibilities included but were not limited to the following: entry of new providers, changes to providers, and other functions with the provider database sub-system of AMISYS
- Support quality review of the database
- Maintain accurate entry of all provider database adds/changes/deletions promptly to ensure prompt and accurate claims payments/pends/denials
- Support manager in daily quality assurance of provider database through entry reviews
- Work cooperatively with all departments to provide the necessary support for all database questions and maintenance, e.g., annual1099 process, DEA, Medicaid #, EOP Error Extract Report, etc., and support configuration of pricing subsystem as it pertains to physician/hospital-specific pricing
Member Services Representative
PARAMOUNT HEALTH CARE
05.2012 - 02.2020
- Duties included but were not limited to handling telephone, written, and walk-in inquiries in a courteous, professional, and thorough manner to assure member satisfaction and education
- Use critical thinking skills and knowledge of benefit procedures to assure correct application of benefits
- Assess when further action is required by sending inquiries promptly to the Research Team, Appeals, Claims, UM, Provider Relations, Membership, Finance, Team Leader, or Member Service Director for appropriate action
- Also, provide input to management on problem trends or patterns to assure correct processing and/or enhance member education and aid the Member Service Department by performing special projects to aid in the smooth functioning of the department
Human Resources Representative
PROMEDICA HEALTH SYSTEM INTERNSHIP
01.2011 - 01.2011
- Completed daily operational and administrative tasks and served as Project Leader for minor Human Resources initiatives as directed by senior leadership
- Aggregated, created, and analyzed workforce data, charts, and reports
- I also attended departmental meetings to assist in the understanding of Human Resources fundamentals
Customer Service Representative
ALLTEL/VERIZON WIRELESS
01.2007 - 01.2010
- Contributed to superior customer service and quality assurance
- Demonstrated diligence, flexibility and innovation geared towards issue resolution
- Achieved all sales and call goals, while answering inbound calls
- Also assisted customers with all inquiries on billing questions and company products
- Verbalized the value of products and services, assuring every client experienced a positive relationship with the organization
Family Health Aide/Tutor
AMERICORPS
01.2004 - 01.2006
- Addressed the critical needs of the youth within the communities of Northwest Ohio
- Assisted East Toledo Community Center with a tutoring program
- Managed mentoring program for disadvantaged youth
- Conducted visits to schools and facilities with children experiencing family and social issues
- Any wrongs
- Coached and developed customer service representatives
Education
MBA - Master of Business Administration
LOURDES UNIVERSITY
12.2020
Bachelor of Science - Human Resources/ Health Care Administration
LOURDES UNIVERSITY
12.2012
Associate of Arts - Business
LOURDES UNIVERSITY
07.2011
Skills
- Customer Care
- Client Relation Management
- Project Management
- Data Analysis
- Call Management
- Mentoring & Coaching
- Team Empowerment
- Scheduling and Reporting
- Organization /Communication
- Benefits administration
- Employee relations
- Microsoft office
- Compliance
- Verbal and written communication
- Written and oral communication
- New employee orientations
Timeline
HR Benefits Representative
ProMedica Health System
03.2022 - Current
Housing Specialist Housing Choice Voucher Program
Lucas Metropolitan Housing Authority
04.2021 - 03.2022
Provider Database Coordinator
PARAMOUNT HEALTH CARE
05.2012 - 02.2020
Member Services Representative
PARAMOUNT HEALTH CARE
05.2012 - 02.2020
Human Resources Representative
PROMEDICA HEALTH SYSTEM INTERNSHIP
01.2011 - 01.2011
Customer Service Representative
ALLTEL/VERIZON WIRELESS
01.2007 - 01.2010
Family Health Aide/Tutor
AMERICORPS
01.2004 - 01.2006
Bachelor of Science - Human Resources/ Health Care Administration
LOURDES UNIVERSITY
Associate of Arts - Business
LOURDES UNIVERSITY
MBA - Master of Business Administration
LOURDES UNIVERSITY
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