Brandii Elbert

Resume of: Brandii Elbert Remote Only/Onsite Resource: Onsite Work Status: U.S. Citizen Availability to Interview: 24 Hours Availability to Start: 2 Weeks Phone Number:- Previous FTE/Contractor: N/A Cleared for Rehire per CWM (Y/N): N/A Previous GuideWell/Florida Blue Hiring Manager: N/A Summary: Brandii has 6 years’ experience in customer service, identification and rectifying to ensure smooth claims handling, in order to accurately verify eligibility and provide benefits provided for members. She has managed in member services and enrollment acting as a source to external provider relations on both contracting and customer care questions. Brandii has experience in end to end provider claim and call quality training. She was chosen for special projects, tracking spreadsheets, and has a full range of provider relations and service interactions. For over a year Brandii has become efficient in Medicare Advantage and Supplement claim handling and billing, issuing checks to providers and members alike. Brandii is currently Marx certified, and has experience in executing the use of the following systems: RBMS, Siebel, Sapphire, Marx, Customer Connect and PIVOT. While working for Florida Blue, Brandii gained complete understanding of compliance with federal and state regulatory requirements, OIR requirements, CMS requirements, HIPPA guidelines, and Grandfathered Plans. Skills: Great communicator Ability to work well under pressure Proper time management Ability to solve problems Strong ability to adapt to any environment Heavy on teamwork Familiar in Microsoft Office, Word, Outlook, Excel and PowerPoint Education: Jean Ribault High School | August 2012 – June 2016 | High School Diploma Professional Experience: Florida Blue | 4800 Deerwood Campus Pkwy, Jacksonville FL October 2019 – Present Universal Service Advocate IV Serviced potential, new and existing customers. Marx Certified Handles all inquires related to CMS, Individual enrollment, billing, reconciliation, delinquency, adds, terms and reinstatements. Resolved questions and issues to help internal and external customers utilize products, tools, services and directly contributed to customer satisfaction and retention across multiple systems Responded to inquiries related to all segments including Medicare Contacted both internal and external customers requiring resolution via outbound telephone, inbound telephone, electronic, and written correspondence. Gained complete understanding of compliance with federal and state regulatory requirements, OIR requirements, CMS requirements, HIPPA guidelines, and Grandfathered Plans. Built relationships with agents and members to maximize the retention of business Executed the use of the following systems: RBMS, Siebel, Sapphire, Marx, Customer Connect and PIVOT. Critically evaluate data through questioning, probing and reasoning for process improvements Became more efficient in the use of Excel to capture and record important data, building charts and graphs, and to sort and filter information. Aetna | 9000 Southside Blvd, Jacksonville FL Jan 2018 – October 2019 Claims Benefit Specialist Processing medical and hospital claims on ACAS platform. Processing claims submitted for rework and ECHS Working on various claims projects and identifying claims errors, root causes and recommending solutions Navigating through appropriate computer systems to finalize claims Reviewing and providing claim status Established guidelines for proper coding/billing for providers Oversaw and ran necessary reports to ensure all statuses were worked in a timely manner and helped in any capacity necessary. Resolved billing issues identified by insurance carriers and patients Monitor and evaluate the effectiveness of solutions, policies, practices and processes to ensure continuous improvement, good client relations and adherence to business requirements. Recommend improvements to achieve and deliver high quality, value-added services. Develop and build internal partnerships to improve communication, coordination, collaboration and effective working relationships within own department and across the Company. Vystar Credit Union | 1831 Dunn Ave, Jacksonville, FL June 2015 - June 2016 Student Manager Intern Combined with internal and external staff to help improve the retention of business Demonstrated initiative, able to work and follow through on assignments without close supervision. Superior written and verbal communication skills needed as well as strong interpersonal, organization and problem-solving skills. Process loan payments, deposits, withdrawals, and cash advances Assists members with safe deposit box access Refers products and services Submits checks for processing through Fiserv Balances cash drawer Spent time as in school branch manager, overseeing the overall running of the branch. Responsible for branch vault and performing vault transactions Ensure through audits that the organization’s programs are consistently administered in compliance with organizational policies and procedures, contractual obligations, rulings, laws and government regulations Serve as a liaison between internal clients and functional departments; help clients achieve their objectives by serving as a resource in the interpretation, application and compliance with internal and external laws, regulations, policies, procedures, standards and practices. Jax Federal Credit Union | 1440-31 Dunn Ave, Jacksonville, FL Jul 2016 – Dec 2018 Member Service Representative Process loan payments, deposits, withdrawals, and cash advances Assists members with safe deposit box access Refers products and services Submits checks for processing through Fiserv Balances cash drawer Processes 23+ transactions efficiently per hour Assist with monthly SMP Audit Responsible for Branch Signage, Rates, and Brochures as well as Monthly SMP Assist teller line when needed Responsible for branch vault and performing vault transactions Demonstrate company’s excellence behaviors on a consistent basis Connect with members to effectively understand their needs and provide products and services that will ultimately benefit them.