Summary
Overview
Work History
Skills
Clients Worked With
Timeline
Generic

Ruth Nelson

Lake Forest,CA

Summary

Self-motivated, reliable Benefits Specialist and Claims Adjuster demonstrating superior understanding of employee benefits and human resource software systems. Astute professional providing benefits support in fast-paced corporate settings.

Overview

25
25
years of professional experience

Work History

Benefits Administrator and Claims Adjuster

EBA&M CORP
Irvine, CA
02.2013 - Current
  • Trained and updated new and existing staff members in GBAS and Anthem Blue Cross systems to process medical and vision claims.
  • Resolved issues and inquiries from client contacts and plan participants regarding health benefits and eligibility through telephone and email.
  • Collaborated with account managers, marketing executives and customer service representatives to resolve claims.
  • Examined claims forms and other records to determine insurance coverage.
  • Monitored clients claims inventory for timely processing, 23 of them contracted with Anthem Blue Cross Networks
  • Established productive working relationships with directors of clients.
  • Reviewed benefits and eligibility system for accuracy and completeness.
  • Identified and communicated enrollment issues to eligibility department.
  • Ran and maintained special projects and reports at request of supervisors, eg; Check Register Audits, Claims Inventory Reports, Error Reports.
  • Managed large volume of medical claims on daily basis including processing claims during staff shortage
  • Located providers for employee medical services.

Benefits Specialist

Proview Advanced Solutions, Inc
Irvine, CA
01.2007 - 12.2011
  • Responsible for managing ongoing administration of all benefits programs (medical, dental, vision, FSA, COBRA, Life)
  • Assisted in setting up client benefit fairs and attended fairs to answer questions and educate employees.
  • Managed client's annual open enrollment periods to ensure timelines were met and ensure employee knowledge of benefits.
  • Checked employees' benefits enrollment for accuracy and inputted all data into BenefitSolver.
  • Resolved issues and inquiries from plan participants regarding health benefits and eligibility through telephone, email and in-person interactions.
  • Explained benefits to clients in easy to understand terms in order to educate each on available options.
  • Administered Flexible Spending plans with strict adherence to IRS regulations and guidelines.
  • Audited processed claims to ensure department standards were met.

Flexible Spending Account Administrator

EBA&M CORP
Irvine, CA
11.2003 - 01.2007
  • Administered Flexible Spending Accounts and Health Reimbursement Accounts.
  • Handled all FSA clients and was direct contact.
  • Established payroll deduction schedule to match client payroll periods.
  • Coordinated participant reimbursement processes and schedules.
  • Entered and processed medical, dental, vision and prescription drug claims for participant reimbursement.
  • Corrected mishandled claims and overpayments.
  • Resolved Customer Service escalated requests.

Skills

  • Excellent Problem Solver
  • Excellent Communication
  • Benefits Explanation Expert
  • Proficient in GBAS, VBA, RIMS, EZ-CAP, Benefit Solver
  • Tech Savy
  • Plan Administration
  • FSA Administration
  • COBRA Administration
  • Data Management

Clients Worked With

Creative Artists Angency

Golden State Foods

ConAm Management Corporation

Oremor Automotive Group

Robinson Helicopter Company

EBARA Technologies

Garden Grove School District

Burlingame Industries


Timeline

Benefits Administrator and Claims Adjuster

EBA&M CORP
02.2013 - Current

Benefits Specialist

Proview Advanced Solutions, Inc
01.2007 - 12.2011

Flexible Spending Account Administrator

EBA&M CORP
11.2003 - 01.2007

Similar Profiles

CREATE PROFILE
Ruth Nelson