SELESTIN GLAMENT RAJ A
Enrollment Associates
Vriddhachalam
Summary
A detail-oriented and dedicated Enrollment Associate with over 7 years of experience in the health insurance sector. Proven expertise in data transformation, Enrolment processes, and managing critical healthcare applications for US citizens under the Anthem project. Skilled in processing Medicare and Medicaid services, Cobra handling a variety of reports, and conducting training for new associates. Seeking to leverage strong analytical and operational skills to contribute to a dynamic team.
Overview
7
7
years of professional experience
Work History
Enrollment Associate
Carelon Global Solution India LLP
06.2019 - 07.2024
- Continued to perform all previous duties.
- States handled: Worked on applications for CA, CO, CT, GA, IN, KY, ME, MO, NV, NH, NY, OH, VA, and WI.
- This involves manually processing the system kickout health applications into the system and achieving daily tasks related to enrollment, plan modifications, reinstatements, terminations, and evaluating applications submitted by the end user.
- Entering the application details into the Enrollment database supplied by the client via the shared mailbox is also part of the process.
- Collecting the necessary information for an application via a shared mailbox, BPM functions, and other resources is essential to finalize the enrollment process.
- A processed request has been received in the shared mailbox, along with submissions through the PEGA tool and BPM tool from both direct customers and internal/external partners concerning inquiries about health coverage for U.S. citizens.
- I reviewed and entered premium checks received from customers into the system and processed refunds to customers for overpayments, coverage issues, or qualification for APTC, CSR, and subsidies. In our enrollment process, we do process Medicare and Medicaid services.
- I reviewed and processed a range of miscellaneous reports, such as home, billing, mailing addresses, phone number changes, dependent additions and terminations, and billing reports.
- I reviewed and processed member data history on the audit trail screen as per the client's request using the work tool.
- Conducted training sessions for new associates on data capture and various billing processes.
- Acting auditor for the audit team and PIP associates.
- Addressing the clarifications posted by associates. Compiling and distributing daily production reports to the team.
- Monitoring and sharing daily inventory received from various queues on a daily and monthly basis with the team lead.
Transaction Processing New Associate
Accenture Solutions Pvt.Ltd
06.2018 - 06.2019
- Continued to perform all previous duties.
- Developed and led new-hire training for the Missing Information team.
- Provided instruction on key operational procedures: generating production and hourly reports, tracking employee absences, following SOD and EOD data protocols, supporting the team, and creating and utilizing checklists.
- I am accountable for managing and processing Code Blue applications in the system within a turnaround time of 30 minutes.
- Offered audit support to external companies, including Carelon Global Solutions, India, LLP.
Contractor Transaction Processing New Associate
Accenture Services Pvt.Ltd on Behalf of 2Coms Consultancy PVT LTD
04.2017 - 06.2018
- States Handled: Worked on applications for CA, GA, CO, and NV.
- Data Transformation: The project's goal is to convert data from the BPM paper application tool into the client-specified electronic IE3 Maps format.
- Missing Information Management: Our team is responsible for contacting members to acquire the missing information needed to process applications.
- Communication Protocol: We communicate with members and brokers via established channels, including Numen letters, a shared mailbox, and RightFax.
- Application Processing: Applications are processed once all valid and necessary information has been received.
Education
Bachelor of Computer Applications -
Thanthai Hans Roever College Arts And Science
Perambalur, India 04.2001 -
Higher Secondary School Certificate -
Fatima Matriculation Higher Secondary School
Vriddhachalam, India 04.2001 -
Secondary School Leaving Certificate -
Fatima Matriculation Higher Secondary School
Vriddhachalam, India 04.2001 -
Skills
- Health Plan Administration
- Data Management & Processing
- Quality Assurance & Auditing
- Medicare & Medicaid Services
- Billing & Finance
- Regulatory Compliance
- Workflow Management Tools
- Database Systems
- Communication & Collaboration Tools
- Reporting Tools
- Associate Training
- Mentorship & Support
- Performance Monitoring
Timeline
Enrollment Associate
Carelon Global Solution India LLP
06.2019 - 07.2024
Transaction Processing New Associate
Accenture Solutions Pvt.Ltd
06.2018 - 06.2019
Contractor Transaction Processing New Associate
Accenture Services Pvt.Ltd on Behalf of 2Coms Consultancy PVT LTD
04.2017 - 06.2018
Bachelor of Computer Applications -
Thanthai Hans Roever College Arts And Science
04.2001 -
Higher Secondary School Certificate -
Fatima Matriculation Higher Secondary School
04.2001 -
Secondary School Leaving Certificate -
Fatima Matriculation Higher Secondary School
04.2001 -
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