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Jeff Stevens
Health Plan Specialist
Summary
Highly skilled and experienced Health Plan Specialist with a proven track record of developing and implementing health plans that reduce healthcare costs and improve patient outcomes. Expertise in health insurance product knowledge, Medicare and Medicaid eligibility determination, claims processing, utilization management, case management, and customer service. Demonstrated ability to collaborate with healthcare providers and negotiate favorable contracts with health insurance carriers. Seeking to leverage my skills and experience to make a significant contribution to a reputable organization.
Education
Bachelor’s Degree in Health Administration
June 2018
Skills
- Health Insurance Product Knowledge
- Medicare and Medicaid Eligibility Determination
- Claims Processing
- Utilization Management
- Case Management
- Customer Service
Work Experience
Health Plan Specialist
- Negotiated contracts with health insurance carriers to secure favorable terms for clients.
- Provided expert guidance to clients on health insurance coverage options and benefits.
- Developed and delivered training programs on health insurance for clients and employees.
- Managed complex health insurance claims and ensured timely and accurate payment.
Health Plan Specialist
- Developed and implemented health plans for over 500 individuals, resulting in a 10% decrease in healthcare costs.
- Analyzed health insurance policies and made recommendations to improve plan design, resulting in a 5% increase in member satisfaction.
- Managed a team of health insurance agents and achieved a 95% customer retention rate.
- Collaborated with healthcare providers to develop and implement care management programs that improved patient outcomes and reduced costs.
Accomplishments
- Implemented a new claims processing system that reduced turnaround time by 25%, enhancing efficiency and member satisfaction.
- Developed and launched a health plan comparison tool that simplified plan selection and increased member engagement by 30%.
- Collaborated with healthcare providers to establish streamlined referral processes, reducing administrative burden by 20%.
- Conducted comprehensive plan audits that resulted in the identification of over $5 million in cost savings for the organization.
- Led the development and implementation of a member education program that improved health literacy and reduced unnecessary healthcare utilization.
Awards
- Recipient of the National Health Plan Specialist of the Year Award, recognized for exceptional contributions to the field.
- Won the Excellence in Health Plan Administration Award for innovative solutions that improved healthcare delivery.
- Received the Health Plan Specialist Leadership Award for outstanding mentorship and guidance to junior colleagues.
Certificates
- Certified Health Insurance Specialist (CHIS)
- Certified Case Manager (CCM)
- Certified Utilization Review Analyst (CURA)
- Claims Processing Professional (CPP)
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How To Write Resume For Health Plan Specialist
- Quantify your accomplishments with specific metrics and results to demonstrate the impact of your work.
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Essential Experience Highlights for a Strong Health Plan Specialist Resume
- Develop and implement health plans for individuals and groups, resulting in reduced healthcare costs and improved health outcomes.
- Analyze health insurance policies and make recommendations to improve plan design, leading to increased member satisfaction.
- Manage a team of health insurance agents to ensure excellent customer service and achieve high retention rates.
- Collaborate with healthcare providers to develop and implement care management programs that improve patient outcomes and reduce costs.
- Negotiate contracts with health insurance carriers to secure favorable terms for clients.
- Provide expert guidance to clients on health insurance coverage options and benefits, empowering them to make informed decisions.
- Develop and deliver training programs on health insurance for clients and employees, enhancing their understanding of coverage and benefits.
Frequently Asked Questions (FAQ’s) For Health Plan Specialist
What is the role of a Health Plan Specialist?
A Health Plan Specialist is responsible for developing, implementing, and managing health plans for individuals and groups. They work closely with clients, providers, and insurance carriers to ensure that health plans meet the needs of members and achieve desired outcomes.
What are the key skills required for a Health Plan Specialist?
Key skills for a Health Plan Specialist include health insurance product knowledge, Medicare and Medicaid eligibility determination, claims processing, utilization management, case management, customer service, and negotiation skills.
What are the career prospects for Health Plan Specialists?
Health Plan Specialists have a wide range of career opportunities, including roles in health insurance companies, healthcare providers, government agencies, and consulting firms. They can advance to management positions, such as Health Plan Manager or Director of Health Insurance Operations.
What is the salary range for Health Plan Specialists?
The salary range for Health Plan Specialists can vary depending on experience, location, and employer. According to Salary.com, the average salary for Health Plan Specialists in the United States is around $65,000 per year.
What are the educational requirements for Health Plan Specialists?
Most Health Plan Specialists have a bachelor’s degree in health administration, public health, or a related field. Some employers may also require additional certifications or licenses.
What is the job outlook for Health Plan Specialists?
The job outlook for Health Plan Specialists is expected to grow faster than average in the coming years due to the increasing demand for healthcare services and the need for qualified professionals to manage health plans.