Hi, I’m
Nicole Woitel
Newport,WA
Overview
6
years of professional experience
6
years of post-secondary education
Work History
Premera Blue Cross
Membership Specialist
09.2023 - Current
Job overview
- Responsible for identifying, resolving and documenting complex reconciliation discrepancies independently, processing refunds, request transfers of premiums, reinstatements, and insufficient fund issues, processing new enrollment and/or eligibility changes as needed and maintaining accurate and comprehensive notes
- Validate appropriate accounts receivable by conducting detailed reconciliation and audit of group or individual premiums and membership of moderate to complex difficulty
- Utilize various tools/ appropriate system reports, such as in Access or Excel to aid in updating eligibility, enrollment and/or reconciliation of accounts
- Must meet or exceed department metrics: production and quality standards and remain current on company/departmental policies and procedures
- Create written correspondence letters using the appropriate system regarding billing and enrollment issues
- Research, investigate and resolve complex account discrepancies, premium rate, bill flag suspension and/or corrections and billing issues, reproduce and create customized or manual bills as needed or requested by customer, and ensure timely and accurate maintenance and reporting of inventories
- Partner with internal /external partners and members to review and resolve issues; may include Web portal usage and contract interpretation
- Conduct complex electronic file accounts receivable and enrollment reconciliation
- Educate members, brokers, or groups on membership and billing processes, administrative rules to include portal usage and contract or policy interpretation
- Contact clients or state agencies to resolve high volumes of electronic feed and/or web entry issues identified via internal reporting
- Analyze enrollment status and apply contract provisions for each enrollment scenario, make changes to records, and research and resolve enrollment system rejections
- Validate Identification Cards are generated in a timely manner
- Respond in a timely manner to all incoming/outgoing member/broker/internal department phone calls
- Ensure compliance with federal and state regulations
- Other duties as assigned
Premera Blue CrossSpokane, WA
Enrollment & Eligibility Specialist
04.2021 - Current
Job overview
- Responsible for reviewing and processing paper and electronic plan applications, plan changes and other member eligibility or payment related requests and applying specific rules inherent to each enrollment scenario
- Apply contractual state and federal guidelines as appropriate and utilize various databases in support of business rule application
- Coordinate and manage enrollment and eligibility exception processes to ensure contract guidelines are met
- Meet and sustain all department production, performance, and quality standards and remain current on company/departmental policies and procedures
- Prepare written member or group communications utilizing department standards and templates
- Initiate and respond directly to groups by phone call and or email
- Communicate timely and effectively with various internal departments, producers, agents, subscribers or group administrators regarding eligibility, billing, and payment inquiries
- Assist with enrollment auditing and business requires
Premera Blue CrossSpokane, WA
Sr. Customer Service Representative
04.2020 - 04.2021
Job overview
- Answered phone and assisted member with changes to their accounts
- Maintained up-to-date knowledge of customer accounts
- Explained eligibility and benefits to members/providers
- Confirmed payments, refunds, etc
- Requested refunds on accounts
- Suggest information about other products and services
- Provided excellent technical support
Premera Blue CrossSpokane, WA
Customer Service Representative
06.2019 - 04.2020
Job overview
- Answered phone and assisted member with changes to their accounts
- Assisted customers in person during counter calls
- Maintained up-to-date knowledge of customer accounts in both employer and individual markets
- Explained eligibility and benefits to members/providers
- Confirmed payments, refunds, etc
- Requested refunds on accounts
- Suggest information about other products and services
- Provided excellent technical support
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Education
Clark Fork Jr./Sr. High SchoolClark Fork, ID
High School Diploma
09.2011 - 06.2015
North Idaho CollegeCoeur D'alene, ID
Associate of Science from Aviation Maintence
01.2016 - 05.2018
Skills
- Application review
- Eligibility procedures
- Telephone etiquette
- Benefits administration
- Confidentiality
- Data entry
- Microsoft office
Timeline
Membership Specialist
Premera Blue Cross
09.2023 - Current
Enrollment & Eligibility Specialist
Premera Blue Cross
04.2021 - Current
Sr. Customer Service Representative
Premera Blue Cross
04.2020 - 04.2021
Customer Service Representative
Premera Blue Cross
06.2019 - 04.2020
North Idaho College
Associate of Science from Aviation Maintence
01.2016 - 05.2018
Clark Fork Jr./Sr. High School
High School Diploma
09.2011 - 06.2015
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