Tania McCauslin
Schenectady,NY
Summary
Dynamic and detail-oriented Associate Benefits Consultant with a comprehensive background in designing and delivering customized employee benefits packages. Experienced in guiding small to midmarket clients through benefit selection and management, prioritizing compliance and satisfaction. Exceptional communicator and team player with proven expertise in customer service, regulatory standards, and process optimization. Implementation Coordinator with extensive experience in project coordination, client management, and comprehensive benefit analysis. Proven track record of efficiently managing complex accounts, facilitating seamless integration, and providing excellent customer service. Adept at using various tools and software applications to ensure the highest standards of accuracy and quality in all deliverables.
Overview
30
30
years of professional experience
Work History
Associate Benefits Consultant
GTM Insurance
02.2024 - Current
- Support the Senior Account Manager with the architecture of tailor-made benefits packages for clients
- Play a pivotal role in crafting and delivering top-tier employee benefits and expertise to guide small and midmarket clients through selection, customization and ongoing management, ensuring both satisfaction and compliance with regulatory standards
- Take customer service calls answering questions about health insurance, workman's comp and disability
- Perform audit for clients on United Healthcare, CDPHP ext
- Load new clients on to Employer Navigator and maintain it
- Sign up new clients for disability
- Write up work flows and help train new hires
Implementation Coordinator
Anthem, Inc. (Previously Empire Blue Cross Blue Shield)
09.2018 - 08.2023
- Receive completed sales package/gain form and Salesforce Tasks
- Review gain from and Salesforce Tasks and related documents for accuracy and completeness
- Verify missing /inaccurate information/document with Sales
- Verify benefits/rates, if non-standards are included ensure appropriate signoff is attached and rider numbers are assigned
- Open all JIRA's that are necessary for standard and non-standard benefits
- Track any JIRA's opened until they are tested and closed
- Created project plan, Benefit plan design and Group structure document for large complex accounts
- Track the production and release of ID cards
- Produce and release the applicable group contract/schedule of benefits/financial service agreement Rider
- Ensure Installations Access Database is completely updated
- Hold Client meeting and produce the Decisions and Deliverables list and send out meeting minutes after holding the meetings
- Help with Training of New Hire's
Implementation Specialist II
Anthem, Inc. (Previously Empire Blue Cross Blue Shield)
11.2011 - 09.2018
- Receive completed sales package/gain form and Salesforce Tasks
- Review gain from and SalesForce Tasks and related documents for accuracy and completeness
- Verify missing /inaccurate information/document with Sales
- Verify benefits/rates, if non-standards are included ensure appropriate signoff is attached and rider numbers are assigned
- Open all JIRA's that are necessary for standard and non-standard benefits
- Track any JIRA's opened until they are tested and closed
- Created project plan, Benefit plan design and Group structure document for large complex accounts
- Track the production and release of ID cards
- Produce and release the applicable group contract/schedule of benefits/financial service agreement Rider
- Ensure Installations Access Database is completely updated
Membership & Billing Reconciliation Representative
Anthem, Inc. (Previously Empire Blue Cross Blue Shield)
09.1996 - 11.2011
- Maintain Applications and coverage for subscribers through verbal and written correspondence with Appointed Group Benefit Administrators
- Resolve routine and complex written and telephone/hotline inquiries involving enrollment, eligibility, billing and premium payment from external customers and Group Benefit Administrators
- Specifically responsible for training of new hires
- Volunteer to learn Aces to help process Connecticut's work
- Assist other departments as needed including Direct Pay, Child Health Plus, Customer Service, Small Group
Senior Underwriter
Anthem, Inc. (Previously Empire Blue Cross Blue Shield)
05.1996 - 09.1996
- Review and approve an applicant's eligibility for coverage following guidelines and limitations set forth by the State of New York
- Make phone calls to any applicant whose application was not completed to obtain the necessary information for processing
Claims Clerk
Anthem, Inc. (Previously Empire Blue Cross Blue Shield)
11.1994 - 05.1996
- Responsible for sorting claims to be sent for scanning, sorted and distributed interoffice mail and Proficient in the use of the Opex machine in opening and distributing of the general mail
Education
Certificate - Life/Accident & Health
Bryant & Stratton College
Certificate - Information Processing
Educational Opportunity Center - Hudson Valley Community College
Troy, New YorkHigh School Diploma -
Bethlehem Central High School
Delmar, New YorkSkills
- Typing: 70 wpm
- Lotus Notes
- CS90
- Extensive Experience with MS Excel
- Gain Form
- WGS
- Salesforce Expertise
- Sharepoint
- One Note
- JIRA
- WebEx
- Extensive Experience with MS Office
- Applied Epic
- Dems
- Employee Navigator
- Isolved
- Microsoft Teams
- Client onboarding
- Customer service
- Benefits administration
- Employee training
- Healthcare benefits
- Benefit plan design
- Project management
- Employee benefits expertise
Additional Information
Excellent communication skills - written and verbal., Very thorough and detail oriented., Enjoys providing quality service to consumers.
Work Preference
In-office or remote roles
Timeline
Associate Benefits Consultant
GTM Insurance
02.2024 - Current
Implementation Coordinator
Anthem, Inc. (Previously Empire Blue Cross Blue Shield)
09.2018 - 08.2023
Implementation Specialist II
Anthem, Inc. (Previously Empire Blue Cross Blue Shield)
11.2011 - 09.2018
Membership & Billing Reconciliation Representative
Anthem, Inc. (Previously Empire Blue Cross Blue Shield)
09.1996 - 11.2011
Senior Underwriter
Anthem, Inc. (Previously Empire Blue Cross Blue Shield)
05.1996 - 09.1996
Claims Clerk
Anthem, Inc. (Previously Empire Blue Cross Blue Shield)
11.1994 - 05.1996
Certificate - Information Processing
Educational Opportunity Center - Hudson Valley Community College
High School Diploma -
Bethlehem Central High School
Certificate - Life/Accident & Health
Bryant & Stratton College
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