Krystal Vigliante
McAllen,TX
Summary
Highly self-motivated, responsible individual with proven case management. Multi-task oriented with excellent time management and researching skills. Perform responsibilities with high degree autonomy either in an individual workspace or a part of a Team. Focused on excellence in job performance and teamwork to obtain optimal results while displaying a high level of interaction with outside individuals (Ex: Clients, Brokers, and Providers.). Provide excellent interpersonal relations, Mentoring, and organizational skills with elite communications skills developed through work employment history. Looking to seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
10
10
years of professional experience
Work History
Contracted through Seaglass Technology Partners
Wex Inc
11.2023 - Current
- Processed Cobra plan renewals for clients while maintaining their standard and adhering to outlined client contracts by utilizing application with UnifyHR
- Such renewals would consist of rate changes, carrier changes, plan terminations, and configuration of new carrier plans outlined in client Open Enrollment Questionnaire submitted via case and direct email to Plan Service Team
- Configured eligibility rulesets by creating a portal for participants to utilize to select new plan s offered via Open Enrollment, this would include applying a Forced or Passive renewal selection trigger
- Verification of newly built or renewed plans on existing outbound files, if new plan or carrier configuration details were submitted, a new outbound file would be created
- This would allow all participant enrollment information to be distributed to designated carriers through secure electronic files feeds
- Additionally, billing was reviewed on a terminated carrier to identify payments submitted/not submitted for active employees Leave of Absence benefits
- Contributed to the current migration by entering data in to secure portals with gained access from Director and higher management
- Verified Cobra documents and letters to be timely distributed to clients’ Active employees and Cobra participants while adhering to Cobra Compliance regulation standards.
Special Projects/Credentialing
Anderson Regional Medical Center
10.2022 - 07.2023
- Assigned to ARMC business office/Revenue department operations requiring maintenance and updating to fit current practice and efficiency
- Worked as Interim Bad Debt/Collections Manager overseeing past due accounts or those requiring financial assistance to bring account current
- Worked closely with Corporate Financial Officer to very those accounts requiring write off of debt or reduced payment options depending on each patient’s capability to resolve
- Assisted Denials Manager to bring past due payer denied medical claims to current standard to resolve discrepancies to allow overdue denied claims to be paid
- Identified several Mississippi Medicaid denied claims to Provider Identification Number (NPI) and incorrectly entered taxonomy number by developing a program to highlight deficiencies
- Assisted in correcting NPI and Taxonomy though Mississippi Medicaid Secure Portal to have claims processed and paid to recover hospital debt
- Updated and corrected the hospitals Physician records to ensure all Licensure and medical credentials were up to date with Mississippi state standards to allow ARMC to maintain relationship with all current providers
- Onboarded new physicians to two separate clinics within ARMC verifying and processing applications with current credential avoiding delay in physician/patients claims being processed and paid out.
Client Risk Analyst
Charles Schwab
02.2022 - 12.2022
- Assisted clients with opening a stock account with Charles Schwab through evaluating the risk by verifying their true identity
- Evaluate cases coming through the queues and asses the discrepancies with past known address’ and criminal backgrounds
- Worked with other departments to process and close accounts that were found to be opened fraudulently
- Special clearance to process certain confidential information was given to me for my daily workload
- Accepted incoming calls from potential and active clients requesting to make changes to account profiles after verifying the risk treat, as well as, corporate account changes being made to add and or remove active profile managers while maintaining excellent customer care and understanding of conflict
- My position was the first line of defense for incoming clients, it was necessary to be fully alert and maintain all information processed for those reviewing the account to understand the history of the clients.
Benefit Coordinator
dmDickason Personnel Services
05.2019 - 01.2022
- Benefits coordinator for internal and external clients to ensure employees know what benefits are offered by the company
- Assisting employees with the enrollment process for savings and insurance schemes
- Submit garnishments with employees and inform employees about any changes to the benefits structure or deductions
- Calculating what the employees will have to pay per pay period
- Open enrollments and keeping up-to-date records of each employee's benefit profile
- Review and revise reports for external clients and their employees
- Audit reviews along with ACA Reporting and coding
- Cobra Compliance Reports, Enrolled employees
- Communicating with insurance and savings providers to resolve issues and conducting presentations that educate employees about their benefits
- Ensuring the company’s benefits and leave-of-absence policies comply with law.
Benefit Service Specialist
ADP
12.2013 - 08.2019
- Interpreting and processing pending enrollments per governing regulations and policies
- Providing guidance to employees and clients and applying Evidence of Insurability (EOI) forms in accordance with standard operating procedures as it relates to employee and labor relations; Review, manage and balance workload with published service level agreement
- Reviewing employee relations policies and procedures to ensure consistency in their submission for benefits along with reviewing the quality of work performed by team Recommending modification and determining areas of benefits while fulfilling client needs according to policy, handling significant issues and concerns, and providing recommendations for changes according to each situation making workload assignments
- Analyzing and resolving particularly complex and sensitive employee/client relations problems and issues such as those involving conflict with policies or other requirements and those involving employee benefit problems and questions
- Resolved workplace issues and maintained an efficient workflow
- Coordinating tier two support with the designated Customer Lead; Assessing the impact and implication of pending discrepancies facing third party/clients
- Serving as an employee advocate to benefit providers for claims issues
- Working closely with benefit providers to resolve eligibility and vendor invoicing issues
- Reconciling monthly premium invoices received from benefit providers to create invoices for HRB and Workforce Now (Current Version)
- Providing fully reconciled invoices to the client and/or the ADP Employees Finance Department for payment
- Facilitated and configured benefit plans for annual enrollment periods for multiple clients at a single time period to ensure their employees were able to update and elect their coverage seamlessly and effortlessly over phone and via email
- Maintaining my client’s eligibility through the Consolidated Omnibus Budget Reconciliation Act and the Affordable Care Act as they apply through State and Federal Law
- I worked closely with the team and served as a main knowledge reference for performance improvement and system redesign projects
- Served as a mentor/trainer to new benefit service specialists; by being the primary point of contact for client’s annual enrollment and performing quality assurance according to policy, provided orientation and on-the-job training along with maintaining and assisting the Standard Operating Procedures (SOPs).
Education
Bachelor of Science -
El Paso Community College
El Paso, TXHigh School Diploma -
El Paso High School
El Paso, TX06.2003
Skills
- Strong Communication Skills
- Learning Styles Adaptation
- Peer Tutoring Support
- Patience and Empathy
- Study Skills Coaching
- Feedback provision
- Goal Setting Assistance
- Problem-solving skills
- Records Management
- Project Management
- Technology Integration
- Project-based learning
Knowledge Skills Experience
Formally Licensed with General lines – life, accident, health and HMO
References
Upon Request
Timeline
Contracted through Seaglass Technology Partners
Wex Inc
11.2023 - Current
Special Projects/Credentialing
Anderson Regional Medical Center
10.2022 - 07.2023
Client Risk Analyst
Charles Schwab
02.2022 - 12.2022
Benefit Coordinator
dmDickason Personnel Services
05.2019 - 01.2022
Benefit Service Specialist
ADP
12.2013 - 08.2019
Bachelor of Science -
El Paso Community College
High School Diploma -
El Paso High School
Similar Profiles
SHANNA TUTTSHANNA TUTT
Agility Engineer/Sr Scrum Master at WEX IncAgility Engineer/Sr Scrum Master at WEX Inc
TABATHA MILLERTABATHA MILLER
Customer Service Specialists at WEX IncCustomer Service Specialists at WEX Inc
Shawn SymonetteShawn Symonette
IT Support Specialist II at WEX INCIT Support Specialist II at WEX INC
Jonathan BoulgierJonathan Boulgier
ITSM Systems Administrator at WEX IncITSM Systems Administrator at WEX Inc
Ashley M. OlivarezAshley M. Olivarez
Immigration Services Officer (1801, GS 7) at Citizenship and Immigration Services (USCIS) (Full-Time, 40 Hours)Immigration Services Officer (1801, GS 7) at Citizenship and Immigration Services (USCIS) (Full-Time, 40 Hours)