Verified
This profile is verified using an email address.
Gloria Clark
Houston,United States
Summary
Detail-oriented Patient Care Coordinator and Healthcare Operations Professional with expertise in benefits administration and regulatory compliance. Skilled in auditing medical, dental, and vision benefit plans while managing client accounts with accuracy and high-quality service delivery. Strong analytical skills support effective management of claims, billing, and eligibility, driving process improvements and exceptional results in fast-paced environments.
Overview
1
1
Certification
5
5
years of professional experience
Work History
Medicare Supplemental Account Specialist
Blue Cross Blue Shield IL
, United States
09.2025 - Current
- Review and analyze Medicare Supplement applications for underwriting, new enrollment, and Guaranteed Issue (GI) while ensuring regulatory compliance.
- Process 50-70 applications daily using LifePro and OnBase, maintaining high levels of accuracy and quality assurance.
- Verified applicant demographics, billing, banking information, policy data, and agent licensing to enhance accuracy in account management and policy administration.
- Researched and resolved application discrepancies using Accurint, ensuring timely processing and delivering exceptional client service.
- Created policy amendments and processed enrollment updates while supporting operational improvements through detailed auditing and compliance reviews.
Client Support Analyst
Cigna
, United States
07.2024 - 12.2024
- Utilized Benefit Sculpting Tool (BST), Blueprint, and ePro to ensure accurate updates of Summary of Benefits, eligibility, and benefit plan information, enhancing client satisfaction.
- Conducted benefit analysis, plan sculpting, and Federal Mental Health Parity reviews to support implementation and client account management, ensuring compliance and optimal service delivery.
- Collaborated with implementation managers, underwriting teams, and client consultants to deliver accurate benefit packages and successful client implementations.
- Identified process improvements and resolved benefit discrepancies to maintain compliance with legislative and HIPAA requirements, contributing to operational integrity.
- Audited medical, dental, and vision benefit plans to ensure benefit accuracy, quality assurance, and regulatory compliance.
Account Installation Associate Analyst
Cigna
, United States
06.2023 - 02.2024
- Coordinated benefit installations for new and renewing client accounts by reviewing implementation source documents, ensuring timely and accurate outcomes.
- Partnered with implementation managers, client account teams, underwriting, and internal business partners to resolve benefit discrepancies and support successful client implementations.
- Audited medical, dental, and vision benefit plans, Summary Plan Descriptions (SPDs), and Summary of Benefits to ensure quality assurance, benefit accuracy, and HIPAA compliance.
- Utilized Benefit Sculpting Tool (BST), ePro, Vista, Blueprint, PBAB, and OnBase to analyze, update, and audit benefit information while maintaining regulatory and legislative compliance.
- Analyzed benefits, verified eligibility, and audited documents to enhance operational efficiency and accuracy, contributing to increased client satisfaction.
- Researched complex plan provisions and resolved client benefit requests, maintaining accurate benefit documentation across medical, dental, and vision product lines.
Patient Access Specialist
Aetna CVS Health
, United States
06.2022 - 11.2022
- Verified patient eligibility, coordinated benefits, and collaborated with healthcare providers to secure authorizations for medical services and equipment.
- Processed prior authorizations, referrals, reimbursements, and benefit inquiries, ensuring timely and accurate resolution for accounts.
- Provided comprehensive client support by assisting members with Medicare, Medicaid, eligibility, benefits administration, claims processing, billing, and insurance verification.
- Maintained accurate documentation and researched complex member issues while delivering exceptional customer service in fast-paced healthcare environment.
- Managed high-risk accounts, grievance and appeal cases, overpayment investigations, and quality assurance reviews while maintaining HIPAA compliance.
- Utilized AssureCare to support care management, pharmacy services, and member account management.
Patient Access Specialist
Anthem Blue Cross Blue Shield
, United States
07.2021 - 03.2022
- Supported Medicare, Medicaid, and retiree populations by educating on benefits, resolving eligibility issues, and coordinating with internal departments to optimize client outcomes.
- Processed authorizations, referrals, billing inquiries, and benefit requests while maintaining HIPAA compliance and regulatory standards.
- Provided comprehensive client support by assisting members with grievances and appeals, benefits administration, eligibility, claims processing, provider contracts, and insurance verification.
- Investigated complex member concerns, researched claim discrepancies, and documented case outcomes to ensure timely and accurate resolution.
- Maintained quality assurance through detailed documentation, account analysis, and effective communication with members, providers, and cross-functional teams, ensuring compliance and satisfaction.
- Utilized AssureCare for care management, pharmacy services, and member account management, enhancing overall service delivery.
Education
Master of Business Administration -
University of Houston-Downtown
United States12-2023
Bachelor of Business Administration - Healthcare Administration
American InterContinental University
United StatesSkills
- Medicare
- Medicaid
- Claims Processing
- Billing
- Regulatory Compliance
- HIPAA
- Auditing
- Quality Assurance
- Policy Development
- Compensation and Benefits
- Insurance Coordination
- Healthcare Providers
- Patient Care Authorizations
- Medical Equipment
- Underwriting
- Operational Audit
- Operational Improvement
- Operational Support
- Process Improvement
- Customer Support/Service
- Client Interaction
- Customer Satisfaction
- Customer Retention/Renewal
- Data Analysis
- Analysis Skills
- Documentation
- Maintain Compliance
- Time Management
- Operational Strategy
- Operations Management
- Operations Processes
- Process Development
- Salesforcecom
- Blueprints
- Genesys Solutions
- Avaya Software
- Microsoft Office
- Microsoft Product Family
- Customer Relationship Management
- Demographics
- Risk Management
- Training/Teaching
- Quality Management
- Quality Metrics
- Cross-Functional
- Problem Solving Skills
- Detail Oriented
- Industry Standards
- Order Delivery
- Psychiatry and Mental Health
- Customer Acquisition
- Communication Skills
- Quality Management
- Quality Metrics
- Training/Teaching
- Detail Oriented
- Industry Standards
- Claims Management
Certification
- Human Resources Certificate
- Leadership Certificate
Timeline
Medicare Supplemental Account Specialist
Blue Cross Blue Shield IL
09.2025 - Current
Client Support Analyst
Cigna
07.2024 - 12.2024
Account Installation Associate Analyst
Cigna
06.2023 - 02.2024
Patient Access Specialist
Aetna CVS Health
06.2022 - 11.2022
Patient Access Specialist
Anthem Blue Cross Blue Shield
07.2021 - 03.2022
Master of Business Administration -
University of Houston-Downtown
Bachelor of Business Administration - Healthcare Administration
American InterContinental University