Carmella H

Over 15 years of progressive experience in HR Customer Service Group Health Insurance Benefits. As a seasoned professional and Subject Matter Expert to all things benefits, I'm heavily relied on to receive, review and resolve inquiries at all employee levels. Solid experience with health insurance, HMO, PPO, Major Medical plans with strength in Life Insurance claims processing.

My background includes Supervising work assignments to maintain target objectives, production oriented with strong analytical, technical skills and a strong work ethic. Proven ability to de-escalate a concern of the employee with confidence to address the next steps to resolve concern.

Experience in cross-functional highly effective teams strong demand teams. Depended on to interpret plan documents to determine and advise next steps to answer questions with integrity. Coordinate wellness initiatives and Open Enrollment activities. Proven ability to implement proactive procedures that deliver timely results.

Corporate HR Benefits Specialist - Horizon Group Holdings - Newark, Delaware

(2025-02)

• Subject matter expert to support the day to day administration of the Health & Welfare benefits programs (health, dental, vision, short and long term disability, life, AD&D, FSA plans for all employees
• Responding to benefit related inquiries and questions
• Experienced with self-insured medical plans
• Claims and Benefits inquiries
• Carrier File connections – errors and updates
• Broker Acquisition support and testing
• New Hire Benefits Communications for enrollment

HR & Benefits Coordinator - AmerisourceBergen - Chesterbrook, Pennsylvania

(2017-08 - 2024-11)

• Provide all associates counselling on eligibility, provisions and other matters related to all benefits offered by AmerisourceBergen Corporation.
• Troubleshoot and resolves all benefit related policy and procedure questions that are escalated from Tier 1 or assigned via the case management system. Investigates and promptly responds to requests from internal and external audit.
• Validate weekly vendor files to HRIS for payroll processing. Maintains a high degree of confidentiality relative to personal health information, salary data and associate benefits information maintained in the Human Resources Information System (HRIS).
• Continually support ways to improve associate services and enhancements to existing associate benefits programs. Researches and responds to complex questions regarding interpretation of benefits plans. Assists with the annual Open Enrolment process.
• Complies with appropriate policies, procedures, safety rules and HIPAA regulations. Demonstrated to be an essential independent contributor.

Benefits Coordinator - QVC Inc. - West Chester, Pennsylvania

(2012-09 - 2017-08)

• Served as the employees' first point of contact regarding Health Insurance, Wellness, Savings and Retirement, Investment in Learning, Employee Program and various HR programs, policies, processes as well as practices.
• Responds to plan eligibility determinations with appropriate and consistent administration of any employment laws such as ERISA, COBRA and HIPAA. Responsibilities also included plan eligibility determinations, appropriate and consistent administration of any compliance with employment laws with QVC HR policies.
• Providing guidance, direction and answers at all levels of employee and management and/or directing them to the appropriate individual while tracking inquiries in the database for case management.
• Tuition Reimbursement, Processing of National Court Orders and benefit verification's along with conducting New Hire Orientations.

Front Desk Associate (Part-Time) - Holiday Inn Express

(2014-05 - 2017-12)

• Serviced as first point of contact to guests providing superior Customer Service with kindness and professionalism.
• Assisting with check in process, inquiries and questions promptly and willingly.
• Relied upon to multitask with other areas of housekeeping and facilities to ensure smooth communication and good experience for customer
• Strong and proactive organizational skills

Risk Specialist - People Share Staffing at QVC Inc.

(2011-09 - 2012-01)

• Review orders in a timely manner and expedite completion
• Analyze membership data using multiple search engines to make determination
• Exercise high judgment in the review and approval of orders based on data

Supervisor, IPPO Claims Operations - Independence Blue Cross - Philadelphia, Pennsylvania

(2008-01 - 2010-12)

• Supervise the daily activities of the Call Center and claim analyst team.
• Ensures that accurate and efficient responses are given to members while processing of claims to meet the operations standards and BCBSA performance standards, policies, and procedures.
• Provides work leadership, assistance technical support expertise and training to those supervised. Analyses workflow and makes adjustment to the process as needed.
• Schedules and organizes staff to accommodate immediate and anticipated workflow volumes. Served as the next level contact for problems that staff cannot resolve.
• Attain and maintain the Inter-Plan Performance and Scorecard Index standards and gain all available points on a monthly basis.

Technical Advisor, Medicare Member Outreach - Independence Blue Cross - Philadelphia, Pennsylvania

(2002-01 - 2008-12)

Member Service Representative – Premier Unit - Independence Blue Cross - Philadelphia, Pennsylvania

(2000-01 - 2002-12)

Senior Member Service Representative - Independence Blue Cross - Philadelphia, Pennsylvania

(1998-01 - 2000-12)