Ryan Davis

• Design, build, test, deploy & maintain benefits to ensure proper claims processing/payments.
• Subject matter expert on projects/committees: ACA/Small Group lines of business, ETF(government employee plans) and Commercial(large group plans), Medicare & Medicaid.
• Research & resolve complex claim processing & build issues.
• Update yearly benefit documentation such as Summary of Benefits, Schedule of Benefits and Certificates of Coverage to ensure they align with state mandates.
• Develop policies & procedures for complex claim pends.
• Interacted with internal customers to understand business needs and translate into requirements and project scope.

• Analyze benefit builds to locate/resolve issues with benefits processing on claims
• Answer complex benefit related questions from various departments via CRM,ServiceNow and other forms of communications.
• Run & work financial impact reports.
• Build benefit plans within FIRE, Chronicles & Tapestry
• Work weekly reports designated to the Benefit Configuration team
• Assist with QMA plan builds
• Assist all Benefit Configuration Analyst with their projects/needs.

• Daily Responsibilities:
• -Completing Dental Pretreats within 24 hours
• -Completing Predetermination of Benefits within 24 hours
• -Answering benefit related CRMs within 3 days
• Responding to benefit related emails within 24 hours
• -Researching complex benefit related claims issues & questions
• -Responding to Emails from other departments regarding benefit related question/issues.
• -Weekly production reports
• -Processing claim pends
• -Interviewing & Training New Hires
• -Updating P&Ps
• -Meeting Quality/Accuracy & Financial Goals

• Daily Responsibilities:
• -Completing Dental Pretreats within 24 hours
• -Completing Predetermination of Benefits within 24 hours
• -Answering benefit related CRMs within 3 days
• Answering benefit related emails within 24 hours
• -Researching complex benefit related claims issues & questions
• -Responding to Emails from other departments regarding benefit related question/issues.
• -Weekly production reports
• -Processing claim pends
• -Building new Benefit Plans in FIRE
• -Meeting Quality/Accuracy & Financial Goals

• Answer inbound calls from our self-funded groups as well as providers.
• Place outbound calls as required.
  
• Provide exceptional customer service by ensuring members & providers understand their benefits for both medical and prescription drug program, prior authorization requirements and procedures as well as their provider network.
• Efficiently log all communications in CRM.
• Assist members and providers with claim processing questions, research denials if needed and send claims back for reprocessing as required.
  
• Monitor, log and respond to Emails, MyPlanTool & MyChart messages.
• Scan and upload member & provider claims correspondences into Onbase as well as tasking information to Claims if adjustments are required via Claim Adjust Form.
• Researching complex benefit and claims processing questions as needed.
• Monitor and complete tasks requested by my fellow colleagues on a daily basis.
  

• Answer inbound calls from members on Commercial, State/Local & Badgercare policies as well as Providers in a queue based setting.
  
• Provide exceptional customer services by ensuring members understand their benefits for both medical and prescription drug program, prior authorization requirements and procedures as well as their provider network.
• Efficiently log all communications in CRM.
• Assist members and providers with claim processing questions and tasking to other departments if further research is needed.
• Assist members with account changes such as address or Primary Care Physicians.
• Promote and answer questions regarding value added programs such as Fitness First & More and Perks & Savings.
  

• Built 500+ client account portfolio, involved addressing customer questions and concerns regarding products, prices, availability and maintaining client satisfaction.
• Interactive audio/visual system designs for private residences,places of worship, schools and universities including instructional guides for contractors and installers. Numerous projects ranging from $50K-$100K in product.
• Increasing project revenue by identifying areas forupselling clients on additional products.
• Maintain a working pipeline for business development, following up on new leads as well as inactive clients to generate business. As a result, saw continuous yearly growth of 15%-30%.
• Successfully completed company transition from terminal based point of sale system to Microsoft Dynamics AX ERP while maintaining great customer satisfaction.
• Fulfilling orders from planning to processing purchases for clients, reviewing purchases for fraudulent activities, processing payments and collecting on net accounts when necessary.
• Recommending products to customers based on their needs and interests. Providing wholesale and resale clients with their discounted pricing.
• Maintaining relationships with vendors to be first to hear of new product offerings and launches.
• Daily tasks including answering incoming telephone calls and emails with professional and knowledgeable responses in a timely manner.
• Training and coaching new employees

Answered inbound phone calls and emails to assist the National Sales Representatives' clients when they were unavailable with basic order info, ETA's and tracking information.