Senior Advocate Skills

• Utilized bilingual communication skills to communicate with and effectively resolve client questions and concerns regarding employee benefits.
• Utilized established contacts and created new business relationships through effective communication and networking to resolve escalations.
• Created and maintained positive and open communication with agents regarding their existing and prospective clients.
• Required professional communication with business officials as well as networking abilities.
• Provide professional communication and personalized service through research and inquiry resolutions.
• Provide legal counseling/support to individuals to facilitate communication with opposing parties.
• Respond to customer inquiries through appropriate communication vehicles.
• Provide monitoring and direct link of communication between seniors and family members with an on-line link.
• Utilize strong written and verbal communication skills to deliver responses to both customers and Regulators.
• Utilized various communication mediums (phone, email, written, etc.)
• Maintain a high level of communication with all facilities and offices as needed.
• Maintained communication with key court officials, social workers and medical staff.
• Have used many different social media tools for communication and for marketing purposes
• Validate the eSign from the network communication - to the back-end integration, to the sign display unit.
• Identified gaps in communication with Precertification tool in efforts to create efficiency for the department.
• Educated participants on devices such as laptops, tablets, and smart phones Improved intergenerational communication in person and regarding technology

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• Identified/confirmed pricing/reimbursement for patients &/or health care providers.
• Train and provide technical assistance to legal, health and social services professionals in community based organizations and health care providers.
• Provide a comprehensive resource to patients, physicians, other health care professionals, payers, manufacture representatives, etc.
• Partnered with Health Care Agencies to train seniors on ways to live more independently in their own homes, etc.
• Work in tandem with Medicare to insure all Plan Participants receive excellent health care and coverage.
• Help guide and educate members about the fundamentals and benefits of consumer-driven health care topics.
• Advocated for appropriate behavioral health care for insured lives in private and public sectors.

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• Provided support to service advocates with coverage and eligibility questions.
• Fostered interest and development to grow our commercial lines presence and became a resource to all advocates regardless of region.
• Coached Service Advocates through tough member scenarios to provide a one call resolution for the member.
• Assisted in process improvement by creating job aids to provide guidance and direction to Service Advocates.
• Discussed alternative solutions with other departments to gain a better call center experience for Service Advocates.
• Motivated Service Advocates to engage in employee activities to create a positive call center atmosphere.
• Ensured the training material was up to date and provided to the advocates being trained.
• Assisted in training new team members to improve their skills and performance as client advocates.
• Advised other advocates (both attorney and non-attorney) about complex legal and policy questions.
• Provide training, supervision, and oversight to SRI Victim Advocates within regional assignment.
• Trained new advocates to independently interview potential clients and represent clients at hearings.
• Assisted nurses and advocates with processing refills, resolving discrepancies using standard procedures.
• Worked with judges and advocates to suggest sanctions for clients.
• Provided daily and weekly progress to supervisors and advocates.
• Facilitate case staffing with junior care advocates.
• Trained 6 new peer advocates.
• Conduct research, problem solving and investigative operations for escalated issues Mentored and coached customer service advocates
• Catalyzed performance excellence by mentoring 19 Healthcare Advocates.
• Meet with various project managers and trainers to assist with new workflows for Service Advocates.
• Mentored and trained supervisee Care Advocates in new skills development and technical applications.

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• Provide behavioral health case management for LTSS Medicaid population both community and facility based.
• Review clinical assessments and certify levels of care according to benefit plan, clinical guidelines, and applicable Medicaid policy.
• Research and resolve and questions or concerns regarding Medicaid, Medicare, Medicare Part D, and Reverse Mortgages.
• Review Medicaid applications, use of Spousal Refusal and Supplemental Needs Trust documents in preparation of filing.
• Serve as the Member-Provider Advocate for all managed care Medicaid and Medicare contracts administered by our company.
• Managed hospital accounts educating them on Medicare, Medicaid and Commercial lines of business.

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• Assist in the planning and implementation programs relating to the development and nurturing positive relationships of the Provider Network.
• Preserve a positive relationship with Rochester City School District.
• Maintain positive relationships between the health plans, providers (hospitals.
• Reviewed resident records and developed positive relationships with each teen.
• Conducted parent meetings to inform parents on how students are doing in the program as well as build positive relationships.
• Mentored caseload of 20 students; developed & sustained positive relationships with youth and families.

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• Provided outreach and organizing services statewide to existing and developing mental health consumer groups and organizations.
• Advocated statewide for families, children, youth in the educational, juvenile justice and mental health systems.
• Connect them to medical care, financial services, mental health services and other resources as necessary.
• Created multiple New York State mental health initiatives for outpatient treatment in the community to prevent re-hospitalization.
• Organized and participated in a Speaker's Bureau comprised of consumers of mental health services.
• Initial, concurrent and post-service clinical reviews for inpatient and outpatient mental health cases.
• Provided information and referral and complete mental health referrals for clients wanting therapy.
• Collaborate with Berkeley Mental Health and Mobile Crisis.
• Ensured members received the mental health services needed.

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• Take escalated phone calls and supervisory issues from fellow provider advocate representatives.
• Responded to phone calls and e-mails to the Borrower Advocacy Department for general information and dispute status.
• Performed basic administrative duties, such as clerical, faxing, filing and screening phone calls.
• Answer phones and fax documents when needed.
• Led administrative operations that included: paperwork, screening/answering phone calls, utilizing the fax/photocopier machine, and customer/patient interaction.
• Answered transferred and responded to ER department phone calls and provided general emergency department information.

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• Provided second-level expertise in a call center and web-based chat-environment to internal and external customers.
• Process basic policy and account related questions/transactions from internal and external customers using AS400.
• Communicate with internal and external customers about underwriting policies and customer accounts.
• Provided Technical assistance and customer service for internal and external customers.
• Handled escalated calls/emails from representatives and external customers.
• Provided complex technical advice, risk selection, integrity and assistance to internal and external customers via E-mail and/or telephone requests.
• Respond to internal and external customer inquiries via phone and/or email in a positive and professional manner.
• Analyze, clarify and resolve basic auto insurance policy and account related questions from external customers.
• Educate and consult both internal and external customers by identifying customer's needs and offering solutions.
• Analyze, clarify and resolve complex policy and account related questions from internal and external customers.
• Maintain good rapport with internal and external customers by taking ownership and projecting an attitude of service.

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• Process claims and correct member information, handle complex issues for members
• Underwrite auto and home policies Team lead and point of contact to help with complex issues
• Skilled in communicating effectively with a multiple discipline team dealing with complex issues resulting in Soldiers/Veterans having exceptional results.
• Provided exceptional ability to build productive relationship, resolve complex issues and win customers loyalty.
• Research complex issues across multiple databases in order to resolve customer issues/resolve escalated issues.
• Researched complex issues across multiple databases and worked to resolve member issues and/or partner with others to resolve escalated issues.

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• Work collaboratively with other internal resources to meet provider networking goals and objectives.
• Respond and develop the provider network narratives for quarterly, semi-annual and annual reporting to State of New Mexico government.
• Assist with physician, and Home and Community based provider network development under coordinated efforts with sales and clinical staff.
• Assist in the development of programs designed to improve the quality of services delivered to the provider network.
• Communicate policy changes and processes of all lines of business to Provider Network via Hand-outs and meetings.
• Evaluate GeoAccess/business intelligence reports to identify the member's access to care and provider network gaps in care.

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• Work with internal business partners to determine root cause of issues affecting claims payments.
• acted as the point of contact for issues escalated to me and worked with business partners to resolve issues.

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• Make outbound calls to patients to obtain further information and also fax out for prescription information.
• Serve as a customer service representative that manages both inbound and outbound calls for clients.
• Conduct outbound calls to clarify, follow-up, and resolve inquiries from customers.
• Handled inbound/outbound calls to patients, neurologists, and specialty pharmacies.
• Receive inbound calls from members concerning their insurance plan.
• Conduct inbound/outbound calls to potential clients in multiple campaigns* Sell/up sell medical devices* Enter client insurance information into database.

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• Provide individualized counseling and crisis intervention for students.
• Provided and coordinated crisis intervention and advocacy to survivors of sexual violence thorough a crisis line and in person.
• Responded to off site locations to provide advocacy and crisis intervention services to recent sexual assault survivors.
• Provide intensive Casework, Crisis intervention, and Counseling to Chronically Mentally Ill adults within Assertive Community Treatment Program.
• Provided crisis intervention, advocacy-based counseling, and domestic violence education to shelter residents and crisis line callers.
• Ensured relevant community resources and communication techniques were utilized to provide effective crisis intervention with individuals requesting assistance.

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• Partnered clients with community resources, jobs, education, and other extra-curricular activities (e.g., GED services).
• Meet with member in various settings to help facilitate assistance with the community resources.
• Provided Community Resources for Adult Children of Seniors.
• Educate vulnerable members of community in lifestyle choices, medication, benefit navigation, available community resources and agencies.
• Coordinated community resources and offered counseling to patient victims of domestic and substance abuse.
• Provide individual support/mentoring and advocacy to youth and make referrals to community resources/programs.

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• Reviewed gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs,

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• Assist retirees who are turning 65 with questions about Medicare, and their insurance options going forward.
• Researched Medicare supplement and Part D plans for patients nationwide.
• Conduct Physician Education regarding CMS and Medicare compliance models.
• Assisted agents for Medicare D Pharmacy Help Desk.
• assigned to the Texas Retired Teachers accounts, assisting Plan Participants in their Traditional as well as their Medicare Advantage plans.

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• Worked with director of network management, developing and implementing strategies resulting in data integrity and customer service.
• Managed wide variety of customer service and administrative tasks to resolve customer issues quickly and effectively.
• Audited call center representatives for accuracy, quality of customer service, and other training opportunities.
• Created procedures to increase customer service and improve customer satisfaction to ensure positive rapport.
• Provide excellent customer service to all customers including internal employee customers.
• Cross-trained customer service associates and backed up other customer service managers.
• Provided advanced customer service to policyholders and insurance agents.
• Delivered superior customer service with each customer interaction.
• Analyzed incoming call data to find areas for improvement for training, scheduling and procedures to increase productivity and customer service.
• Provided professional, prompt and accurate customer service via telephone and in writing to members, groups, doctors etc.
• Attended several seminars regarding customer service and was named Farmers Employee of the month twice for exceptional customer service.
• Deliver excellent customer service to 170-200 calls per day providing customer with a one call resolution
• Job Duties: Customer service agent who handled escalated calls from all areas of Sears.
• Trained the entire sales and customer service team on how to sell home care services
• Demonstrated skill and performance resulted in leadership role for a dedicated customer service team.
• Maintain high levels of efficiency and provide excellent customer service while building the brand.
• Track and follow up with customer service issues to assure 100% customer satisfaction.
• Act as a customer service advocate, managing member's comprehensive insurance services.
• Provided customer service over the phone for current and new customer.
• Manage scheduling for staff members while providing excellent customer service.

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• Provide HIV, Hepatitis C and STI testing and screening services and counsel clients on safe sex practices.
• Served as Senior Defense Counsel and Senior Special Victim Counsel.
• Assisted counsel in preparing answers, providing documentation and information for discovery request.
• Monitored and counsel students on credit accumulation and graduation requirements.
• Provide ongoing strategic counsel on media relations to president/founder.
• Participated in negotiating a settlement with opposing counsel.

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• Trained underwriting colleagues on underwriting guidelines in preparation for service center expansion into new states.
• Applied new developments in underwriting guidelines to new and existing business document.
• Evaluated policy applications for compliance with underwriting guidelines
• Serve as an underwriting subject matter expert in my department by sharing my knowledge and assisting coworkers with complex underwriting guidelines.
• Hold expertise in the company's billing, policy processing and underwriting processes and best practices.
• Educated agents about underwriting guidelines and coverages for new and existing business.

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• Assisted with policy issues and escalated calls.
• Serve on the front office phone team, answering inbound agent questions regarding variousdocumentation requirements and policy issues.

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• Received the 2013 Annual Award for Community Service.
• Worked in partnership with Washington Park Partners in coordinating community improvement projects, and developing community service work sites.
• Identify and secure community services for adults with disabilities to ensure affordable housing, financial stability and medical services
• Coordinated projects such as cultural development and community service endeavors for the southern regional advisory boards.
• Provide information or refer individuals to public or private agencies or community services for assistance.
• Facilitated psycho-social therapy groups, assigned youth to community service placements and monitored progress.

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• Improved healthcare services documentation and coding accuracy by consulting with providers and clinicians while simultaneously enhancing overall quality of patient care.
• Collected information regarding overall patient care and satisfaction of their hospital experience and presented findings and recommendations to hospital administration.
• Demonstrate team member responsibilities, direct and indirect patient care responsibilities that require judgments, accountability and follow through.
• Selected for participation in Patient Care Services Committee, reporting any significant patient issues from patient/parent perspective.
• Collected, compiled and submitted data into an electronic database maintaining confidentiality and ensuring timely patient care.
• Maintained heavy communications with patients, referring physician and staff regarding patient care and administrative responsibilities.

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• Assisted senior aged victims of domestic violence to understand their rights and the legal remedies available to them.
• Provided information on the Prevention of Domestic Violence Act, victim rights and resources available.
• Conduct lethality screenings with victims of domestic violence.
• Monitored exported hearings for orders of protection, contested orders of protection hearings and family court cases involving domestic violence allegations.
• Provided community-based and legal advocacy services for victims of domestic violence & sexual assault along with their non offending family members.
• Coordinate public awareness events, especially those centered around domestic violence awareness month and sexual assault awareness month.

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• Serve as escalation point for software inquiries, sales, contractual and/or billing issues, and call center questions.
• Answered incoming calls (about 60/day) from customers and insurance agents to resolve underwriting and billing issues.
• Assisted with all billing functions including commission, payment history, payment credits and complex billing issues.
• Work with agents and customers resolving complex billing issues.
• Worked with customers to solve email deliverability, web site visibility, domain ownership/transfer and billing issues.
• Research and solve claim/billing issues working with the member through the resolution of their problem.

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• Serviced customer Accounts, maintained back office administration for endorsement requests, and Audited new business documents submitted for approval.
• Handled agency calls regarding complex underwriting philosophies, policies and marketing initiatives to service customer accounts.
• Provided recommendations for the application of clinical criteria and parameters of benefits for customer accounts.

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• Collaborated with Hudson County Probation Office and DCCAP to provide optimal client services.

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• Conduct prevention and awareness classes on the topics of domestic abuse and sexual assault.
• Provided emotional support, information, and community referrals to multilingual/multicultural survivors of sexual assault in hospital setting immediately following incident.
• Completed 40 hours training and provided advocacy and support to sexual assault/domestic violence survivors in hospitals and/or police departments.
• Provided information and assistance to victims of sexual assault on availability of testing for sexually transmitted diseases.
• Provide confidential sexual assault and domestic violence victim support, including medical, legal and general advocacy.
• Provide supportive crisis counseling services using an empowerment model for individuals experiencing Sexual Assaults and Domestic Violence.

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• Review problems and communicates with appropriate personnel to obtain unique resolutions when necessary.
• Review customer issues or problems and work with appropriate personnel to obtain information and find resolutions, when necessary.
• Assessed problems and obtained information, escalating issues to appropriate personnel as needed.

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• Reviewed and evaluated pertinent information to underwrite personal auto and fire policies.
• Gain knowledge in home and auto insurance, and help agents with questions or issues with quotes or active policies.

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• Provided case management services and prior authorization requests directly to insurance companies.
• Verify patient benefits coverage with insurance companies and report benefits to both patient and physician's office.
• Risk and claim management consultant for heterogeneous captive insurance companies as well as national captive programs.
• Act as a liaison between customers and insurance companies to successfully create partnership in claims adjudication.
• Received high volume of incoming calls from patients/insurance companies/physician offices and other provider calls.
• Research patient account information prior to contacting insurance companies and discussing medical claim.

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• Provided HIPPA guidelines and procedures in reference to release of information services for patients and insurance statues.
• Maintained privacy and confidentiality of participants and employee information following HIPPA and company guidelines.
• Maintain patient confidentiality according to HIPPA guidelines.
• Followed HIPPA guidelines and regulations in assisting members with understanding their benefit and claims information.
• Maintained HIPPA and OSHA guidelines relating administering medications to patients.
• Maintain client confidentiality of personal information per HIPPA.

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• Key Accomplishments: Facilitated the Remove-Vehicle project, which reduced customer complaints and led to retention.
• Provide resolutions to customer complaints and issues that would arise in our team environment.

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• Performed outreach in-services in hospital and outpatient treatment facilities to educate consumers on independent living services, and community supports.
• Supervised at risk youth activities in accordance with applicable regulations and facilitated therapeutic intervention for possible independent living.
• Facilitated groups on independent living skills, money management, empowerment and relationship building.
• Provided direct support to assist individuals with self-advocacy, independent living, and community integration.
• Provide individualized supports to developmentally disabled adults to allow them to improve upon and maintain their skills for independent living.
• Manage and direct an independent living program for therapeutic foster teenagers.

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• Processed intake assessments, maintained client caseload-monitored client files submitted needed documentation.
• Maintained client files according to company policy and contract requirements.
• Completed documentation for client files and statistical information database.
• Complete necessary documentation to maintain client files.
• Managed client files and helped organized agency fundraisers
• Maintained client files with discretion and confidentiality.

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• Complete application put them in the best product of life insurance they quality for.
• Managed and communicated health and life insurance benefits for all 20,000 global employees.
• Updated statement of health and dependent changes in employee MetLife insurance plans.
• Achieved a 90% P&C and 95% life insurance retention rates.

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• Approved documentation and processed policy changes.
• Continue to assist agents with basic policy changes, discounts, billing, etc.
• Assist three agents at a time processing policy changes, and inspection reviews.
• Process policy changes and enforce rules and regulations of multiple states.
• Explain billing processes and assist with complex policy changes.
• Managed policy changes and billing inquiries from customers.
• Process payment and policy changes for policy holders.

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• Prepared and argued motions on a wide range of legal issues.

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• Serve as a point of contact for new hires with the company to help familiarize them with company policies and procedures.
• Uphold company policies and standards while complying with state and federal guidelines

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• Managed a team of staff members in organizing a daily schedule for clients with intellectual and developmental disabilities.
• Trained all new staff members on all benefit types; updates training manuals and provided suggestions for improvement.
• Manage staff members, educating them on proper procedures for care provision and risk reduction techniques.
• Provide guidance and training to staff members.
• Investigate and direct veteran inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution.
• Collaborated with other staff members to complete clinical assessments and effective treatment planning.

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• Evaluated new clients for needs and program qualifications; Followed up to ensure existing clients were being appropriately served.
• Owned and operated legal practice in the areas of taxation with client base over 400.
• Handled a client base consisting of 200 accounts, with multiple claims per account.
• Entered and updated new clients details in the customer relationship management software according to administrative guidelines.
• Screened, interviewed and processed new clients per eligibility requirements.
• Complete intake assessments and provide welcome tours for new clients.

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• Provide targeted preventative and sexual health services to individuals, community groups and organizations.
• Organized grassroots campaigns to advocate for pro-bike policies and infrastructure through collaboration with emerging and existing community groups.
• Collaborate with formal and informal community groups and leaders to develop strategies to better serve target communities and population.
• Addressed community groups and faculty members to present counseling service.
• Created and facilitated intimate partner violence trainings and prevention education programs for professional agencies, treatment, and community groups.

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• Protected confidential information, at all times by following HIPAA privacy rules and regulations.
• Comply with federal regulation in management of clients sensitive personal identifiable information (HIPAA regulations)
• Handled claim denials and/or appeals with confidentiality and following HIPAA regulations.
• Handled highly confidential records and information in accordance with HIPAA regulations.
• Maintain patient confidentiality and HIPAA protected information.
• Ensured legal compliance integrity and confidentiality in accordance with company policy and HIPAA regulations.

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• Build, manage and close member complaint cases in high volume escalations department.
• Enrolled high volume of patients daily to reach a percentage to qualify for a grant.
• Researched potential market share, conducting high volume cold calls in addition to sales leads.
• Maintain organization while updating a high volume of patient records, including experience in EMR.
• Work in high volume emergency room near KARM with homeless and indigent patients.
• Maintained and exceeded a high volume of member enrollments.

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• Organized staff meetings where we addressed client problems and collaborated on resolutions.
• Staff scheduling, processing payroll, staff meetings, management meetings.
• Modified care plans in weekly staff meeting.
• Provided advocacy for shelter clients, attended weekly staff meetings for collaboration, facilitated and led domestic violence education groups.
• Attended monthly staff meeting for continuing education information, case management and debriefing.
• Participated in staff meetings and other professional development opportunities for the department.

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