Korin A. Smith
Bridgewater
Summary
Dynamic Account Benefit Manager with extensive experience at Horizon Blue Cross Blue Shield of New Jersey, excelling in benefit management and client relations. Proven track record in implementing new accounts and enhancing workflows, leveraging strong analytical skills and effective communication to resolve complex issues and drive operational excellence.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Account Benefit Manager
Horizon Blue Cross Blue Shield of New Jersey
Newark
08.2016 - Current
- Interpret and document benefit and account profile information utilized by internal departments to accurately service the client and populate downstream systems
- Oversee and manage the benefits for new and existing groups with 51+ members
- Ensure groups are implemented corrected from the onset to the completion of the implementation process
- Oversee the complete implementation of new accounts and trouble shoots enrollment/claim/ billing issues for the first 30 days.
- Build strong relationships with Account Management teams and Internal Departments to facilitate implementation of benefit changes, new lines of business for existing clients, and triage benefit related issues.
- Conduct off-site client meetings to review benefit documentation, provide recommendations for changes along with cost/saving factors, and obtain client validation
- Assist in pre and post implementation audits
Team Leader
Horizon Blue Cross Blue Shield of New Jersey
Newark
09.2012 - 08.2016
- Managed daily tasks of the staff to ensure the delivery of exceptional customer service
- Oversaw, managed, and distributed claims inventory
- Ensured daily receipts are processed according to Service Level Agreements (SLAs)
- Facilitated and scheduled weekly team meetings
- Evaluated strengths and weaknesses of staff members
- Provided coaching and mentoring to the business team in order to enhance staff performance levels for quality, production, and attendance
- Educated and trained the internal staff and vendors
- Met with each staff member monthly to level set and ensure expectations and goals are met
- Fostered a positive working environment
- Ensured accuracy and compliance with internal/external policies
- Performed appropriate data analysis and reporting
- Facilitated training for internal and external staff
- Participated in UAT testing
- Investigated claims pre and post audit
- Created and established new workflows for process improvement
Supervisor I/Team Coordinator
Horizon Blue Cross Blue Shield of New Jersey
Newark
09.2010 - 09.2012
- Assisted in the daily management of staff to ensure the delivery of exceptional customer service
- Distributed claims inventory
- Ensured daily receipts are processed according to Service Level Agreements (SLAs)
- Facilitated and scheduled weekly team meetings
- Evaluated strengths and weaknesses of staff members
- Provided coaching and mentoring to the business team in order to enhance staff performance levels for quality, production, and attendance
- Educated and trained the internal staff and vendors
- Met with each staff member monthly to level set and ensure expectations and goals are met
- Helped to foster a positive working environment
- Ensured accuracy and compliance with internal/external policies
- Performed appropriate data analysis and reporting
- Participated in departmental and interdepartmental workgroups
- Facilitated training for internal and external staff
- Participated in User Acceptance Testing
- Created and established team workflows
Senior Member Services Coordinator
Horizon Blue Cross Blue Shield of New Jersey
Newark
04.2008 - 09.2010
- Recognized as a leader and selected to participate in the Monday Morning Leadership Program
- Provided Physicians with medical claim information
- Assisted and supervise customer service representatives' phone calls
- Provided training for the customer services representatives
- Developed materials for special projects and meetings
- Researched and resolve physician complaints
- Educated physicians on Horizon’s medical policies, procedures, and billing processes
- Organized and present at team meetings
- Assisted Director special projects and escalated inquiries
- Created workflows to aid in better business practices
- Assisted both vendors with workflows, claim information, and education and training
Member Services Coordinator
Horizon Blue Cross Blue Shield of New Jersey
Newark
01.2007 - 04.2008
- Provided assistance to physicians with medical claim and benefit information
- Updated physician information
- Identified and resolved technical issues
- Researched and escalated physician complaints
- Educated physicians with Accounts Receivables, medical policies, and procedures
- Aided in the reduction of inventory
- Assisted both vendors with workflows, claim information, and education and training
Principle Accounting Clerk
Rutgers, the State University of New Jersey
New Brunswick
07.2004 - 09.2006
- Processed all of the University’s monetary transactions
- Assisted students in making transactions and with account information
- Issued refund checks to students
- Assisted supervisor in special projects
- Directed students in making payment arrangements
- Processed departmental deposits
Medical Assistant
Cardiovascular Interventionalists of Central Jersey
East Brunswick
01.2003 - 06.2004
- Prepared each patient before seeing the doctor by taking vital signs and performing EKGs
- Assisted with the precertification
- Maintained and supervised appointment scheduling
- Answered and triaged all phone calls
- Handled all typing, office work, and patient registration
Education
A.B.S - Christian Counseling
Somerset Christian College
Zarepath, NJ05.2007
Phlebotomy Certification -
Manhattan Institute
New York, NY03.2004
Skills
- Claims processing and inquiry
- Enrollment verification
- Microsoft Office suite
- Data entry and analysis
- Organizational and time management
- Verbal and written communication
- Customer service and relations
- Benefit management
- Account implementation
- Compliance oversight
- Workflow improvement
- Problem solving and decision-making
- Performance evaluation and management
- Partnership development
- Conflict resolution strategies
- Policy development and implementation
- Employee onboarding and training
References
Available upon request.
Certification
NJ Health Producer License
Timeline
Account Benefit Manager
Horizon Blue Cross Blue Shield of New Jersey
08.2016 - Current
Team Leader
Horizon Blue Cross Blue Shield of New Jersey
09.2012 - 08.2016
Supervisor I/Team Coordinator
Horizon Blue Cross Blue Shield of New Jersey
09.2010 - 09.2012
Senior Member Services Coordinator
Horizon Blue Cross Blue Shield of New Jersey
04.2008 - 09.2010
Member Services Coordinator
Horizon Blue Cross Blue Shield of New Jersey
01.2007 - 04.2008
Principle Accounting Clerk
Rutgers, the State University of New Jersey
07.2004 - 09.2006
Medical Assistant
Cardiovascular Interventionalists of Central Jersey
01.2003 - 06.2004
A.B.S - Christian Counseling
Somerset Christian College
Phlebotomy Certification -
Manhattan Institute