View Cart

Certified Resume Writers | Professional Resume Writing Service ~ Starting at Only $99!

The sample below is for a Health Benefits Specialist CV Resume Sample. This resume CV was written by a ResumeMyCareer professional CV resume writer, and demonstrates how a CV resume for an Executive Management CV Resume Sample should properly be created. Our Certified Professional CV Resume Writers can assist you in creating a professional document for the job or industry of your choice.

Get Started Now!

Health/Benefits Specialist

Highly-accomplished, articulate and detail-oriented Enrollment and Benefits Specialist with impressive hands-on knowledge base encompassing entire spectrum of HIPPA and all benefits/enrollment. 15 years experience, 10 years with the military providing superior customer-centric service and support as a trusted representative and liaison. Seek a position where extensive training and experience will assist with benefits coordination, and healthcare enrollment initiatives. Dedicated to maintaining a reputation built on quality, service, and uncompromising ethics. Proficient in MS Office Suite.

CORE STRENGTHS

 Enrollment Benefits Expertise
 Customer Service/Support
 Liaison/Claims Resolution
 HIPPA Regulations Knowledge
 Provider Education
 Cost Effective Healthcare

PROFESSIONAL EXPERIENCE
 Tricare Education Specialist – Health Net Inc., Brunswick, ME 2011to Present
 Perform overall support and planning for events that support Tricare Operations Manual required military briefings and customer support in assigned market areas.
 Communications with service members of varying ranks, categories and pay grades, providing face-to-face support initiatives in Tricare Service Center.
 Maintain event attendance records, develop and submit required reports, and maintain appropriate educational and briefing material to support required military events.
 Travel to various locations supporting military related functions, and provider education relating to Tricare benefits, authorizations/referrals, and claims issues.
Referral Management Center Liaison/ Benefits Specialist – Health-Net, Inc., Brunswick, ME 2006 to 2011
 Performed onsite customer support to walk-in military and service connected personnel.
 Served as liaison among the Tri-care beneficiary, the Military Treatment Facility, Network Providers and the Health Net Best Value Team utilizing cost effective medical resources within direct care and purchased care systems.
 President’s Pool Award for Superior Team Achievement/ 2008, 2009, & 2010.
 Assisted active duty, retired and service family members with complex enrollment, access and claim procedures.
 Resolved enrollment, claims and referral issues, and processed and submitted appropriate forms.
 Assisted in team efforts for “Yellow Ribbon” educational series designed to assist military personnel coming back from overseas to better understand benefits and entitlements.
 Appropriately identified and referred potential personnel to Disease Management, Case Management, Demand Management and Transitional Care.
 Reports all potential issues and grievances to Clinical Quality Management and possible fraud and abuse to Program Integrity, and effectively reconciled data correspondence and all transactions, and effectively kept all records, files and demographics up-to-date.
 Traveled to other Tri-Care Service Centers as needed to assist other civilian providers
Medical Biller/Coder – Coastal Orthopedics, Brunswick, ME 2004 to 2006
 Performed superior customer service and support initiatives with expertise and confidentiality.
 Accurately coded all medical and surgical claims to insurance companies (before electronic submission).
 Managed patient accounts including charges, payments and customer changes, applied insurance payments to patients’ accounts, followed up on all insurance denials, and filed appeals when appropriate.
 Collaborated with collection agencies in cases where attempts to collect money on overdue accounts failed.
 Prepared bank deposits and reconciled daily transactions

Customer Service Representative – Sierra Military Health Services, Brunswick, ME 1998 to 2004
 Provided customer-centric service and support for all incoming beneficiary calls, and provided general information and assistance with inquiries and/or directed to appropriate personnel.
 Logged all call received into a computer database, and managed conflict resolution with difficult personnel, handled complaints and issues in diplomatic and professional manner.
 Reported emergency room visits to insurance companies.
 Verified all beneficiary demographics files were up to date, and traveled to various corporate offices assisting with beneficiary computer and file demographics.

EDUCATION / CERTIFICATIONS / PROFESSIONAL TRAINING
B.S., Criminal Justice – University of Phoenix – Currently enrolled
Business Courses – University of Southern Maine, Portland, ME – One year enrollment
Certificate/Business Administration – Maine Vocational Region 10, Brunswick, ME
Dale Carnegie Training
Government Sponsored Training Courses:
HIPPA, Personal Health Information, Ergonomics, Sexual Harassment

Order From Us Securely at ResumeMyCareer.com