Open To Work
Sonja Roulette
Las Vegas,NV
Work Preference
Summary
Dynamic business professional with extensive experience in the health insurance sector, specializing in claims processing and member support. Proven ability to streamline operations, enhancing productivity and member satisfaction. Strong analytical and communication skills facilitate effective collaboration with teams to align compensation strategies with organizational goals.
Overview
1
1
Certification
15
15
years of professional experience
Work History
Member Service Specialist
Prime Therapeutics
08.2025 - Current
- Answered calls and emails from members, pharmacies, and doctors on medication, benefits, and account inquiries, ensuring clear communication and support.
- Investigated and resolved member inquiries promptly, escalating complex issues to the appropriate team for efficient resolution.
- Completed prior authorizations accurately, facilitating timely reviews by clinical pharmacists.
- Follow standard operating procedures and training guidelines, including those specific to HIPAA.
- Worked from home in Eagan, MN, providing support to members and healthcare providers.
Medicare Benefit Advisor/Licensed Agent
Allstate
05.2024 - 08.2025
- Guided individuals and organizations in navigating complex benefit options, enabling informed decisions and maximizing value from benefits packages.
- Explained health plan options and coordinated with plan vendors to support customer decision-making.
- Educated employees on voluntary group benefits to enhance understanding and utilization.
- Worked remotely from Northbrook, IL
- Life/Health license received 09/25/24
Personal Care Assistant
Freedom Care
10.2022 - 06.2024
- Assisted clients with personal care routines, including bathing, dressing, and oral hygiene, to promote dignity and hygiene.
- Ensured client safety by assisting with mobility and monitoring changes in health conditions, facilitating timely interventions.
- Meal preparation: Planning and preparing meals and feeding clients.
- Companionship: Providing general companionship and social and emotional support.
- Performed housekeeping tasks, including laundry, dishes, vacuuming, and making beds, to maintain a clean and comfortable living environment.
- Developed and implemented individualized treatment plans, utilizing manual therapy and therapeutic exercise.
- Las Vegas, NV
Supervisor/Team Lead/Technical Claims Specialist
UPMC HealthPlan
04.2011 - 09.2022
- Assumed supervisory responsibilities during supervisor's absence, ensuring team continuity.
- Trained and mentored staff by organizing training plans, resulting in improved team knowledge and proficiency in claims processing.
- Established a process for translating and keying foreign claims to enhance claim accuracy and processing speed.
- Developed inventory plans that streamlined processes and reduced excess inventory.
- Worked from home in Pittsburgh, PA
Education
Bachelor of Business Admin/Mgmt. -
Strayer University
Williamsburg, PA01-2024
Bachelor of Science - Nursing
CCAC Boyce Campus
Pittsburgh, PA01-2003
Bachelor of Science - Nursing
Columbus State University
Columbus01-1996
Skills
- Effective communication
- Membership management
- Quality care provision
- Attention to detail
- Data analysis
- Effective communication
- Collaboration skills
- Active listening
- Problem-solving
- Problem-solving
Certification
Licensed Life & Health Agent, 20687323
Timeline
Member Service Specialist
Prime Therapeutics
08.2025 - Current
Medicare Benefit Advisor/Licensed Agent
Allstate
05.2024 - 08.2025
Personal Care Assistant
Freedom Care
10.2022 - 06.2024
Supervisor/Team Lead/Technical Claims Specialist
UPMC HealthPlan
04.2011 - 09.2022
Bachelor of Business Admin/Mgmt. -
Strayer University
Bachelor of Science - Nursing
CCAC Boyce Campus
Bachelor of Science - Nursing
Columbus State University