Melissa Cox
Rio Rancho,NM
Summary
Methodical and versatile Health Insurance Specialist with 15 years of hands-on experience in consulting organizations and individuals on their health insurance benefits. Experience in building lasting relationships within the community through various lines of business including Medicaid, Medicare, Employer Groups, and ACA. Interest in utilizing my skills to pursue new paths.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Data Entry Contractor
ATA Services
05.2023 - Current
- Completed data entry tasks with accuracy and efficiency.
- Organized, sorted, and checked input data against original documents.
- Communicated with supervisors and colleagues to process data quickly and resolve discrepancies.
- Entered data into various computer systems accurately using Microsoft Office Suite and Salesforce.
- Created and maintained data entry logs to track data entry activities.
Medicare Benefit Advisor
Molina Healthcare
05.2022 - 01.2023
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email and in-person interactions.
- Built relationships with local senior centers, and low income assistance centers to provide onsite help to prospects.
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Checked employees' benefits enrollment for accuracy and inputted all data into SalesForce.
- Observed strict procedures to maintain data and plan participant confidentiality.
- Developed and maintained courteous and effective working relationships.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
Benefits Account Manager
Payday HCM
08.2020 - 03.2022
- Directed and controlled medical, dental and vision benefit packages.
- Built and strengthened long-lasting client relationships based on accurate price quotes and customer-centric terms.
- Liaised between account holders and various departments.
- Addressed problems with accounting, billing and service delivery to maintain and enhance client satisfaction.
- Contributed to annual revenue goals by selling new services and developing new accounts.
- Evaluated different providers offering range of services, coverages and plan options to pick optimal choice.
ACA Compliance Specialist /Benefits Coordinator
Payday HCM
10.2015 - 08.2020
- Skillfully developed departmental goals, objectives, standards of performance, policies and procedures.
- Consistently complied with applicable laws and regulations and ensured company adhered to ACA/IRS regulations.
- Educated staff on state and federal statutes, rules and regulations governing ACA Compliance.
- Assisted Native American Pueblos with ACA and benefits administration.
- Interpreted and communicated new or revised policies to staff.
- Routinely collaborated with department managers to correct problems and improve services.
- Served as subject matter expert by advising staff and customers and working directly with external agencies throughout audits or to remedy compliance issues.
- Observed strict procedures to maintain data and plan participant confidentiality.
- Updated benefit cost summaries for employer cost tracking.
- Checked employees' benefits enrollment for accuracy and inputted all data into iSolved.
- Fulfilled reporting requirements of Employee Retirement Income Security Act (ERISA).
Correctional Customer Liaison
ACC Healthcare
07.2014 - 10.2015
- Maintain, grow and develop business relations with correctional and PACE facilities that will inform our clients about our compassionate and non-judgmental dental care for their patient populations.
- Ensure that our clients are supported in providing affordable oral health care that contributes to the general health and quality of life for their populations and our patients.
- Manage customer relationships with 37 correctional and PACE facilities.
- Staff and coordinate dental services at 37 facilities nationwide.
Sr. Project Coordinator
Lovelace Health Plan
07.2013 - 01.2014
- Coordinating and scheduling more than 200 sales and benefit informational meetings for the Annual Election Period.
- Utilizing Quickbase for compliance and Centers for Medicare and Medicaid Service review.
- Conducting sales presentations to prospective enrollees during Annual Election Period.
- Take ownership of assignments, special projects, and other duties as assigned.
- Assisting existing sales reps with seminars and sales during Annual Election Period.
Medicaid Customer Advisor
Lovelace Health Plan
05.2007 - 07.2013
- Retaining current membership and continued to have above a 96% retention rate consistently throughout the 6 years in this position.
- Outreach to approximately 70-80 current medical providers in regional areas in the southeast part of New Mexico as well as Bernalillo County every quarter.
- Outreach and information to current and prospective members in community.
- Ability to work independently or as an effective team member with knowledge of Medicaid line of business policies and procedures.
- Navigated extensive company knowledge base to obtain appropriate solutions for customer service issues
- Held quarterly meetings with members
- Created health fairs and events to engage with the community
Customer Service Representative
Lovelace Health Plan
10.2006 - 04.2007
- Ability to confer with customers both face to face and telephonically, and to demonstrate both professional conduct and the ability to promote a positive image for the company.
- Adhesion to policies, procedures and regulations to ensure compliance and patient safety. Display an extensive working knowledge of departmental practices and operations, while demonstrating continued and consistent proficiency in all skill sets in the call center.
- Strong ability to adhere to schedule on a consistent basis.
- Strong communication, problem solving and organizational skills with the ability to multi-task while maintaining accuracy and consistency.
Education
High School Diploma -
Socorro High School
El Paso, TX05.2000
Skills
- Strong Presentation skills
- Bilingual
- Knowledge of Medicaid statutes and regulations
- Independent judgment and decision making
- Microsoft Office proficiency
- Benefit auditing
- Teamwork and Collaboration
- Planning and Coordination
- Health Benefits and Administration
- Salesforce Experience
- 401K experience
- HRIS and Human Capital Management Systems
Certification
- Licensed NM Life, Accident and Health 2013-Current
Timeline
Data Entry Contractor
ATA Services
05.2023 - Current
Medicare Benefit Advisor
Molina Healthcare
05.2022 - 01.2023
Benefits Account Manager
Payday HCM
08.2020 - 03.2022
ACA Compliance Specialist /Benefits Coordinator
Payday HCM
10.2015 - 08.2020
Correctional Customer Liaison
ACC Healthcare
07.2014 - 10.2015
Sr. Project Coordinator
Lovelace Health Plan
07.2013 - 01.2014
Medicaid Customer Advisor
Lovelace Health Plan
05.2007 - 07.2013
Customer Service Representative
Lovelace Health Plan
10.2006 - 04.2007
High School Diploma -
Socorro High School
- Licensed NM Life, Accident and Health 2013-Current
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