Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

SONYA FLOYD

Louisville,KY

Summary

Illustrate coordination and team leadership. Strategic planner and analytical problem solver with 15 years in the field. Excellent critical thinking and organizational abilities. Proficient in insurance policy coverage levels. Successful at utilizing strong interpersonal skills to present information to policyholders. Highly experienced reviewing claims and determining coverage. Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adapt at working effectively unsupervised and quickly mastering new skills. Hardworking employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience. Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.

Overview

8
8
years of professional experience

Work History

Benefit Consultant

OptumRx
Louisville
08.2021 - 08.2024
  • Provided guidance and assistance on a variety of topics including but not limited to retirement planning options, health plan options, life insurance coverage levels.
  • Developed presentations detailing the features of different types of insurance products offered by the organization.
  • Prepared detailed reports on benefit plan utilization, costs, trends, and compliance issues.
  • Communicated effectively via email, phone and face-to-face with plan participants to resolve issues pertaining to health and welfare benefits.
  • Provided assistance to plan participants by explaining benefits information to ensure educated selections.
  • Checked accuracy and completeness of benefits applications and documents.
  • Ensured compliance with federal, state, and local regulations affecting benefits programs, including ACA and ERISA.
  • Coordinated annual open enrollment process, including preparation of materials, presentations, and employee support.
  • Analyzed benefits usage and cost trends to advise on plan adjustments and negotiations with vendors.
  • Assisted with audits by preparing accounts and providing information.
  • Collaborated with HRIS team to ensure benefits data integrity and streamline enrollment processes.
  • Participated in benefits renewal process, analyzing proposals and making recommendations.
  • Negotiated with benefits vendors to secure cost-effective services for the organization.
  • Implemented wellness initiatives aimed at improving employee health and reducing healthcare costs.

Customer Service Rep Lead

OptumRx-JV Specialty Pharmacy
Jeffersonville, IN
11.2016 - 08.2021
  • Participated in benefits renewal process, analyzing proposals and making recommendations.
  • Collaborated with HRIS team to ensure benefits data integrity and streamline enrollment processes.
  • Negotiated with benefits vendors to secure cost-effective services for the organization.
  • Assisted with the preparation of reports and presentations on benefits programs for senior management.
  • Assisted employees with benefits enrollment and changes, providing guidance on plan options and implications.
  • Ensured compliance with federal, state, and local regulations affecting benefits programs, including ACA and ERISA.
  • Developed presentations detailing the features of different types of insurance products offered by the organization.
  • Conducted employee orientations to ensure understanding of the benefits provided.
  • Negotiated contracts with vendors and suppliers for competitive rates on benefit services.
  • Developed and implemented benefit plans to meet the organization's goals.
  • Resolution specialist, subject matter expert.
  • Collaborate with outside sources to solve more complex problems.
  • Answered customer questions regarding medication, processing of pharmacy benefits, government plans, etc.
  • Researched customer pharmacy insurance plans to provide prior authorization and drug benefit coverage.
  • Handled escalated issues; supervisor calls.
  • Delivered quality care to customers through phone collaboration with a pharmacist.
  • Resolved third-party rejection claims.
  • Created new customer profiles and updated changes, such as demographics, allergies, new medications, and insurance details. In pharmacy computer systems.
  • Assisted other patient care coordinators with escalated issues.
  • Assisted with reship orders, MFR replacements.

Education

Jefferson Community And Technical College
Louisville, KY

Skills

  • Excellent analytical and interpersonal skills
  • Demonstrates strong oral and written communication skills
  • Collaboration experience
  • 20 years health care experience
  • 8 yrs of PBM experience
  • 6 yrs RX Claims systems experience
  • Type 40-45 wpm
  • Microsoft Word advanced
  • PowerPoint advanced
  • Microsoft Excel advanced
  • Insurance/Medicare practices
  • subject matter expert
  • resolution team lead
  • Quality assurance
  • Insurance knowledge
  • Client Relationship Building
  • Highly skilled in RXCOMET
  • Special projects
  • Verbal and written communication
  • ACA standards knowledge
  • Benefits interpretation
  • Documentation And Reporting

Accomplishments

  • Earned over 29 recognition award for performance,compassion, quality, collaboration and relationships
  • Created workaround solutions for a Companywide claim rejection, for major client accounts, BCBS, HealthTrust, etc.
  • Consistently maintained high customer satisfaction ratings.

Timeline

Benefit Consultant

OptumRx
08.2021 - 08.2024

Customer Service Rep Lead

OptumRx-JV Specialty Pharmacy
11.2016 - 08.2021

Jefferson Community And Technical College

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SONYA FLOYD