THAMAR MATHADOR
Revere,MA
Summary
Detail-oriented benefits and healthcare operations professional with over 7 years of experience in health insurance enrollment and compliance documentation. Skilled in resolving complex coverage inquiries and managing data discrepancies, while supporting members, providers, and stakeholders. Expertise in Excel, Workday, SQL, Salesforce, and SharePoint, with a strong emphasis on documentation management and payment reconciliation.
Overview
10
10
years of professional experience
Work History
Commission Analyst
Tufts Health Plan
06.2022 - 11.2025
- Analyzed and reconciled monthly commission, payment, and broker data to ensure accurate reporting, payment processing, and issue resolution.
- Partnered with Accounting, Sales, and internal business teams to research discrepancies, resolve outstanding balances, and support accurate financial transactions.
- Prepared monthly and ad hoc reports using Excel and internal systems to support operational decision-making and compliance requirements.
- Conducted audits of financial and transactional data, documented findings, and recommended corrective actions to improve accuracy and efficiency.
- Managed ERISA-related reporting and supported compliance documentation in accordance with established procedures and deadlines.
- Researched complex payment and eligibility-related issues, identified root causes, and coordinated resolutions with internal departments.
- Maintained confidential financial and business information while following company policies and regulatory requirements.
- Supported process improvement efforts by documenting procedures, identifying recurring issues, and recommending workflow enhancements.
- Communicated professionally with internal and external stakeholders to resolve inquiries in a timely, courteous, and accurate manner.
Benefits Enrollment Specialist
Tufts Health Plan
10.2019 - 06.2022
- Processed and validated high-volume health insurance enrollment data to ensure accurate member eligibility, coverage updates, and compliance with state and federal requirements.
- Researched and resolved complex enrollment, eligibility, and coverage discrepancies by analyzing system records and collaborating with internal departments.
- Assisted with member enrollment updates, coverage changes, and issue resolution related to healthcare benefits and eligibility.
- Supported CMS-related reporting by identifying Enrollment Data Validations, gathering required documentation, and submitting accurate information within deadlines.
- Maintained accurate enrollment records and documentation while handling sensitive and confidential member information.
- Created, reviewed, and updated DocuSign envelopes to support benefit, enrollment, or administrative documentation processes.
- Monitored enrollment workflows for compliance with healthcare regulations, internal policies, and reporting standards.
- Analyzed recurring enrollment issues and recommended process improvements to reduce errors and improve operational efficiency.
- Communicated with internal stakeholders to resolve benefit, eligibility, and enrollment issues in a timely and professional manner.
- Supported daily and monthly reconciliation activities to ensure data accuracy across systems and reports.
Customer Service Representative III
VIKING CRUISES
01.2016 - 04.2018
- Assisted members, providers, employers, and internal teams with health insurance benefits, eligibility, enrollment, claims, billing, and coverage-related inquiries.
- Explained benefit information, coverage details, plan rules, and next steps to customers in a clear, courteous, and professional manner.
- Researched complex member issues using multiple healthcare systems and documented findings, actions taken, and resolutions accurately.
- Resolved high-volume customer inquiries while maintaining confidentiality and compliance with healthcare privacy standards.
- Applied strong conflict resolution and problem-solving skills to de-escalate concerns and determine appropriate solutions.
- Collaborated with internal departments to resolve benefit, enrollment, billing, and claims issues.
- Maintained detailed documentation of customer interactions and ensured timely follow-up on unresolved issues.
- Supported a diverse customer population by providing patient, respectful, and accurate service in a fast-paced environment
Education
Bachelor's Degree - Finance
Southern New Hampshire University
ManchesterAssociate - Finance
Bunker Hill Community College
Charlestown, MA, USSkills
- Benefits Administration Support
- Health Insurance Enrollment
- Eligibility Verification
- Medical, Dental & Vision Benefits Knowledge
- Employee/Member Benefits Support
- Enrollment assistance
- DocuSign
- Retirement Benefits Support
- Unemployment Claims Support
- New Hire Orientation Support
- Qualifying Event & Coverage Change Research
- Benefits Inquiry Resolution
- High-demand client assistance
- Healthcare Compliance
- Confidential Information Handling
- Payment Reconciliation
- Documentation & Record Maintenance
- Policy and Procedure Support
- Vendor/Internal Stakeholder Communication
- Root Cause Analysis
- Issue Escalation & Resolution
- Excel, Pivot Tables, VLOOKUP
- Microsoft Word, Outlook, PowerPoint
- Workday
- Salesforce
- SharePoint
- SQL
- Medicare, Medical Billing, ICD-10 Coding
Title
Benefits Coordinator | Healthcare Enrollment & Benefits Administration | Reconciliation & Employee Support
Additional Information
Authorized to work in the US for any employer
Timeline
Commission Analyst
Tufts Health Plan
06.2022 - 11.2025
Benefits Enrollment Specialist
Tufts Health Plan
10.2019 - 06.2022
Customer Service Representative III
VIKING CRUISES
01.2016 - 04.2018
Associate - Finance
Bunker Hill Community College
Bachelor's Degree - Finance
Southern New Hampshire University