Summary
Skills
Work History
Education
Overview
Generic

Engla Allison

Humble`,TX

Summary

Collaborative individual with expertise in providing exemplary service regarding benefits support. Multitasking Benefits Specialist knowledgeable in state and federal regulations and maintaining employee confidentiality. Diligent Advocate skilled at listening to customers,exceeding productivity targets, and maintaining current knowledge of company offerings. Solves problems quickly to retain customers and delivers high level of service in every interaction.




Skills

  • Policy Knowledge
  • Benefits Administration
  • Research abilities
  • Critical Thinking
  • Relationship Building
  • Benefits Explanation
  • New employee orientations
  • Attention to Detail
  • Interpersonal Communication
  • Calm and Effective Under Pressure
  • Attention to Detail
  • Claims Handling and Coverage Verification

Work History

Benefit Advocate II

Alliant
08.2023 - 06.2024
  • Enhanced client satisfaction by resolving benefits-related issues promptly and accurately.
  • Streamlined benefits enrollment processes for increased efficiency and improved user experience.
  • Developed comprehensive training materials to educate employees on benefits programs and policies.
  • Collaborated with HR teams to ensure seamless integration of benefit offerings into overall compensation packages.
  • Negotiated competitive rates with vendors, resulting in significant cost savings for the organization.
  • Maintained compliance with all federal, state, and local regulations pertaining to employee benefits administration.
  • Assisted employees in navigating complex healthcare systems, ensuring timely access to necessary care and services.
  • Managed relationships with benefits providers to ensure prompt resolution of claims disputes and other issues.
  • Provided ongoing support to employees experiencing life changes that impacted their benefit eligibility or coverage needs.
  • Served as an advocate for employees in addressing concerns related to their benefit plans, providing guidance on available resources and options.
  • Fostered positive relationships between company leadership and employees by serving as a trusted resource regarding all aspects of company-provided benefits.
  • Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
  • Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions.
  • Trained new team members in policies and procedures and offered insight into best ways to manage job tasks and duties.
  • Coordinated and conducted employee orientations to promote understanding of coverage and options.
  • Managed approximately 30 to 50 incoming calls, emails and faxes per day from customers.'

HealthCare Advocate II

Alight Solutions LLC
09.2017 - 06.2023
  • Improved patient satisfaction by actively listening to concerns and addressing their needs promptly.
  • Reviewed applications and screened patients to determine eligibility for medical and disability assistance.
  • Enhanced healthcare service quality by collaborating with medical professionals and providing accurate patient information.
  • Obtained patient feedback from over thousands of patients to provide appropriate recommendations to improve patient services.
  • Discussed patient grievances with management to develop action plans, resolving hundreds of complaints.
  • Delivered comprehensive case management services that ensured continuity of care across multiple providers while minimizing gaps in service provision.
  • Connected uninsured patients to programs to help cover medical expenses.
  • Promoted patient well-being through empathetic communication, advocacy, and personalized care planning.
  • Facilitated seamless transitions between care settings by coordinating necessary resources and support services.
  • Mediated conflicts between patients and medical staff, fostering a collaborative environment focused on positive outcomes.
  • Assisted patients in obtaining necessary medications, maximizing adherence to prescribed treatment regimens for improved health outcomes.
  • Streamlined communication between patients and providers, ensuring timely access to essential health services.
  • Supported patients in navigating the healthcare system effectively, increasing their understanding of available resources and options.
  • Resolved customer complaints using established follow-up procedures.
  • Provided excellent customer service to patients and medical staff.
  • Engaged with patients to provide critical information.
  • Applied administrative knowledge and courtesy to explain procedures and services to patients.
  • Trained new staff on filing, phone etiquette and other office duties.

Insurance Follow-up Specialist

PFG Group
05.2016 - 08.2017
  • Participated in regular staff meetings to discuss and strategize action plans for problematic accounts, resulting in improved collections performance.
  • Provided exceptional customer support to patients and insurance companies, fostering positive relationships and maintaining a high level of client satisfaction.
  • Assisted management in implementing new policies and procedures for streamlining the insurance follow-up process, increasing departmental productivity levels.
  • Implemented efficient workflows for claim submissions, reducing processing delays from insurers.
  • Resolved patient disputes promptly regarding insurance coverage or billing matters.
  • Collaborated with insurance companies to expedite claim processing, improving cash flow management.
  • Developed strong relationships with payer representatives, facilitating faster issue resolution for unpaid claims.
  • Supported team members in resolving complex issues, fostering a collaborative work environment focused on continuous improvement.
  • Streamlined follow-up processes for improved efficiency, ensuring timely resolution of unpaid claims.
  • Improved patient satisfaction by addressing their concerns related to insurance claims and explaining the process in layman''s terms.
  • Reduced denials and underpayments through effective communication with payers, leading to increased revenue.
  • Negotiated payment arrangements with patients facing financial difficulties, enhancing customer loyalty and retention.
  • Managed approximately 30 to 50 incoming calls, emails and faxes per day from customers.'

Customer Service Specialist III

SYSCO Food Services
12.2012 - 11.2015
  • Enhanced customer satisfaction by resolving issues promptly and professionally.
  • Reduced response time for customer inquiries by streamlining communication processes.
  • Managed high call volume while maintaining a courteous and professional demeanor.
  • Increased customer retention rates by providing exceptional problem-solving skills and personalized solutions.
  • Collaborated with team members to create effective strategies for improving overall customer experience.
  • Maintained up-to-date knowledge of products and services to provide accurate information to customers.
  • Developed rapport with customers, fostering long-term relationships and repeat business.
  • Handled escalated calls calmly, finding resolutions that satisfied both the company and the customer''s needs.
  • Conducted thorough research to address complex customer issues, ensuring complete resolution within specified timeframes.
  • Assisted new employees with training, sharing best practices for handling difficult situations and achieving positive outcomes.
  • Tracked customer interactions using CRM software, helping the team identify trends and areas of improvement in service delivery.
  • Provided comprehensive support during periods of high call volume by adjusting schedules to accommodate increased needs efficiently.
  • Adapted quickly to changes in company policies or procedures ensuring consistency in delivering accurate information to customers.
  • Educated customers about available resources such as online FAQs or user guides that could help them resolve future concerns independently.
  • Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
  • Resolved concerns with products or services to help with retention and drive sales.
  • Managed approximately 30 incoming calls, emails and faxes per day from customers.'

Senior Medical Claims Examiner

Amerigroup Medicaid
01.2011 - 12.2012
  • Continuously sought opportunities for professional development, attending industry conferences and participating in relevant training programs.
  • Stayed up-to-date on industry trends to inform decision-making processes and anticipate potential challenges.
  • Consistently met or exceeded performance targets related to claim turnaround times, accuracy rates, and customer satisfaction metrics.
  • Identified areas for cost reduction through meticulous claims analysis and negotiation with providers.
  • Served as a subject matter expert in company audits, providing insights into effective medical claims examination practices.
  • Developed strong relationships with healthcare professionals, fostering trust and cooperation for smoother claims processing.
  • Mentored junior examiners, sharing expertise and guidance to improve overall team performance.
  • Reduced claim denial rates by thoroughly reviewing and validating medical documentation before submission.
  • Improved claim processing efficiency by implementing new medical claims examination practices and procedures.
  • Enhanced team productivity with regular training sessions on industry best practices and regulatory changes.
  • Managed a high volume of complex cases, ensuring timely resolutions while maintaining attention to detail.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Researched and resolved complex medical claims issues to support timely processing.

Healthcare Claims Examiner

Coventry Health Care
01.2009 - 01.2011
  • Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
  • Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
  • Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
  • Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
  • Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
  • Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Provided exceptional customer service by empathetically addressing claimants'' concerns and effectively explaining the claims process to them.
  • Maintained current knowledge of industry developments, regulations, and best practices through continuous professional development activities.

Education

High School Diploma -

Sharpstown High School
Houston, TX

Overview

15
15
years of professional experience

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Engla Allison