Portland, Oregon Metropolitan Area
I'm a firm believer in the ideology that everyday is a new opportunity to learn more, think more, and do more. I have skills & experience with process improvement, policy and procedure development, project coordination, case management, crisis intervention, client advocacy, community outreach, program oversight, training and employee development, critical thinking & collaborative problem solving. Let's connect! 😀
- Develop new basic, voluntary and individual products in conjunction with the Directors of Product & Marketing, Actuarial, Underwriting and IT. - File all products with the appropriate insurance departments, insuring that the correct filing transmittals and required certifications are complete and accurate. - Design and develop auxiliary forms such as group applications, individual applications, health statement applications, enrollment forms and other associated materials for new and revised products and plans and file such forms with the state insurance departments. - Revise current contracts and certificates to be compliant with new laws and regulations and file such revisions with the state insurance departments. - Respond to all correspondence from state insurance departments concerning filing disapprovals, including researching the applicability of the statute or regulation on which disapproval is based, revising and refiling forms if it is determined that the disapproval is warranted, and corresponding with the insurance department to present our interpretation if we do not agree that the disapproval is warranted. - Research, analyze and interpret insurance laws and regulations to determine their impact on LifeMap products, practices and administrative procedures and make recommendations as to procedural changes and/or product revisions. - Review Life and Disability appeals to determine appropriateness of initial claim decision and communicate final appeal determination to members, employers, stakeholders, and appropriate internal teams.
- Data entry and analysis - assist the consulting team in gathering, organizing, entering and analyzing data using Excel spreadsheets to be used for various client projects. This role also involves an increased focus on analysis of the results and managing portions of projects, including reviewing the team's work. Examples of the types of projects and responsibilities include: - Marketing efforts - gather benchmarking, utilization or rate data from the vendors via a Request for Proposal (RFP); interpret the meaning of the data and summarize the responses from the RFP in Excel or PowerPoint format for presentation to the client - Cost projections and vendor renewal workups - gather data from the client and vendors to populate Excel spreadsheets used for developing cost projections and evaluation of vendor renewal workups; results are used as part of client renewal and budget meetings - Tracking claims experience - gather data from client and vendors and check for reasonableness using independent judgment; analyze actual versus expected healthcare costs using an Excel template; results are typically sent to clients on a monthly or quarterly basis - Plan design consolidation - gather data from the client and current vendors needed for analyzing the impact of a client's consolidation of its healthcare plans; typically involves organizing and summarizing plan design details and costs in Excel for further analysis by the team; responsibilities also include checking data for reasonableness and follow-up with vendors regarding missing or inaccurate data
- Investigate, secure and analyze information pertaining to claimants’ medical condition, occupational demands, insured status, and other policy provisions to accurately determine eligibility for, and entitlement to disability benefits - Identify file/fact discrepancies and outstanding issues and secure additional documentation as needed while investigating within prescribed time frames - Make and communicate disability decisions and issue correct benefits for new and continuing claims - Ensure the company’s reserve liability is accurately established by identifying all applicable claim offsets and maintaining accurate claim and system data - Provide responsive and caring customer service to claimants, policyholders, and other internal and external customers; participate actively and effectively in team/department projects and issues
- Manage the administration, documentation, and evaluation of the medication management program. Trains, coaches, and consults with all Residential Counselors who dispense medication - Provide leadership and primary oversight for medication administration records completion, 'Cycle Fill' documentation/ordering, pharmacy coordination and communication, and narcotic medication handling procedures - Schedule medical services appointments, including primary care providers, specialists, dental services, and hospital/E/D visits. Coordinate transportation when needed - Maintain knowledge of, ensure compliance with, and review all applicable federal, state, county, and city regulations and approved internal policies and procedures
- Develop case plan and appropriate goals for all cases assigned in a holistic case planning format, adhering to the Adoption Safe Families Act, with the ultimate goal of achieving the most appropriate permanency plan to meet the individualized needs of each child, and family - Coordinate service delivery within the Department of Human Services' community resources including inner- agency disciplines, the juvenile court, law enforcement agencies, schools and treatment providers - Ongoing face to face meetings with clients at current residence and with their child(ren) in their foster placements; According to the observations and information gained from these meetings, monitor and adjust the service plan for the child(ren)