Jayson Rodriguez
Hialeah,FL
Summary
Effectively utilize my professional experiences and knowledge maintaining growth within the company, managing high-volume clients and accounts, building team dynamics, and displaying excellent communication skills.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Analyst, Account Associate (SE Public & Labor)
Aetna/CVS Health
Sunrise, FL
08.2015 - Current
- Serve as a liaison for Aetna/CVS Health, SBBC administrative office, SLCFD, Sarasota County Government, and City of Hialeah.
- Provide direct assistance for account employees and their dependents.
- Manage group accounts related to eligibility, benefits, claims, and enrollment processes.
- Develop and maintain relationships with client account personnel inside and outside of administrative offices.
- Provided health plan assistance to account employees
- Address and identify all claim and eligibility-related issues and provide resolution in a timely manner.
- Interact with both internal and external employees to promptly resolve issues
- Update enrollment files for employees and their families based on client requests.
- Coordinate and participate in open enrollment and other health-related events annually during open enrollment periods, or as per client requests for specific events.
- Upload and maintain incentive reports or discrepancies on a weekly basis, while correcting error reports based on provided data
- Create and manage a special handling claims project for the School Board of Broward County following the 2018 Stoneman Douglas School incident.
Community Development Coordinator
Aetna/CVS Health
07.2014 - 08.2015
- Developed, facilitated, and implemented outreach activities, special events, programs, and presentations that support member and provider education and health plan awareness with the Medicaid population and community.
- Responsible for developing and maintaining relationships with key community resources and providers in support of member growth and retention goals.
- Maintained marketing guideline compliance with the state's laws and contract requirements.
Senior Eligibility Consultant
Aetna/CVS Health
05.2013 - 06.2014
- Managed group accounts related to enrollment and employee status.
- Updated primary account information per clients' request.
- Provided assistance and support to members, providers, and groups regarding billing and enrollment
- Provided training to all associate eligibility consultants with any procedure changes to group accounts.
- Coordinated Cobra packages for non-eligible members, no longer enrolled with groups.
- Managed billing for members transitioning from Cobra to individual plans.
Senior Communications Specialist
Aetna/CVS Health
12.2005 - 04.2013
- Identified questionable billing practices in accordance with Florida Statutes.
- Provided HIPPA information to members and authorized personnel while maintaining confidentiality
- Liaison to member/internal departments to ensure escalated issues were resolved in a timely manner.
- Conducted investigational reviews to obtain necessary documentation to resolve grievances.
- Interfaced with internal/external clients, including providers, via telephone, written correspondence, fax, web, and/or electronic mail in order to respond to inquiries and resolve issues.
- Train and develop personnel for customer service satisfaction.
- Traveled off-site to provide training and preparations for operations at new call center location.
Education
Associate in Arts - Psychology -
Miami Dade Community College
01.1998
Skills
- Bi-lingual
- Strong written and verbal communication skills
- Proficient in Microsoft Office and other researching/internet tools
- Critical thinker
- Ability to multi-task
- Staffing and training experienced
- Successful sales experience
- Project management experience
- Multiple Priorities Management
Certification
Florida 2-15 Health Life & Variable Annuities
Timeline
Analyst, Account Associate (SE Public & Labor)
Aetna/CVS Health
08.2015 - Current
Community Development Coordinator
Aetna/CVS Health
07.2014 - 08.2015
Senior Eligibility Consultant
Aetna/CVS Health
05.2013 - 06.2014
Senior Communications Specialist
Aetna/CVS Health
12.2005 - 04.2013
Associate in Arts - Psychology -
Miami Dade Community College