Amanda Toth

Amanda Toth 535 Lakeview Dr. Spring Grove, PA-- Professional Experience January, 2020 to present Harrisburg, PA PENNSYLVANIA HEALTH INSURANCE EXCHANGE AUTHORITY Plan Management Lead • Work to help stand up and establish a health insurance state-based exchange. • Work with insurers to ensure that they meet agency, state and federal standards. • Assist insurers with meeting plan certification requirements for the exchange. • Coordinate meetings with insurers, solicit and document feedback, and maintain insurer SharePoint site. • Consult in the development of plan and broker certification requirements, and insurer and member portals. • Work cooperatively with the Pennsylvania Insurance Department to guarantee compliance with state law. July, 2001 to January, 2020 TUFTS HEALTH PLAN Watertown, MA Senior Document Development and Filing Specialist, April, 2005 to January, 2020 Benefit Contract Development Specialist I, March, 2003 to April, 2005 • Prepared regulatory benefit document filings for the states of Massachusetts, New Hampshire, and Rhode Island. • In conjunction with several internal departments, including Appeals, Sales, and Medical Policy, catalogued requested changes and managed the biannual benefit document change process. • Created benefit document templates for both fully-insured and self-insured clients. • Assisted in the development of several new plan designs and their accompanying benefit documents for both fully and self-insured products, including tiered products. • Created benefit documents and worked with the representatives of the company’s two largest clients to ensure accurate completion of their annual benefit document revisions. Documentation Specialist, July, 2001 to March, 2003 • Prepared annual benefit documents for client groups and produced original documents for new groups. • Worked cooperatively with other departments in compiling and producing benefit documents in a timely manner. • Responded to various requests for documentation by locating documents or ordering documents from vendors. • Produced document amendments for members and client groups. • Assisted in editing current documents for future use. September, 2000 to July, 2001 MCKINSEY & COMPANY Waltham, MA Human Resources Administrator/Recruiting Coordinator • Enrolled new employees in benefits and oversaw employee onboarding process. • Resolved benefits problems for current employees. • Assisted in year-end retirement program enrollment/options determination. • Sourced candidates for various positions via web postings and cooperation with search firms. • Managed candidate progression through the interview process. • Maintained various spreadsheets and databases, including candidate pipeline spreadsheets and information database, candidate source listing, and compensation information spreadsheet. • Coordinated interviews with managers and travel arrangements for candidates. • Prepared offer letters and literature for new hires. January, 2000 to September, 2000 PROGRESSIVE INSURANCE COMPANY Needham, MA Claims Representative • Investigated insurance claims and performed coverage investigations. • Interviewed insured parties, claimants, and witnesses. • Determined liability for losses. • Prepared reports on findings and negotiated settlement with claimants and other insurance carriers. • Responsible for complete and detailed file documentation. May, 1995 to December, 1999 OPTIMIST FOSTER FAMILY AGENCY Los Angeles and Long Beach, CA Supervising Social Worker (March, 1997 to December, 1999) • Responsible for oversight and generation of solutions to crises. • Interfaced with clients and contractors. • Responsible for overseeing the job performance of up to six social workers. • Ensured compliance with agency protocol, professional standards, and state and county regulations. • Aided in recruiting and hiring staff; responsible for training new staff. • Reviewed and edited all documentation and reports generated by staff. • Assisted in writing program statement for admission into Child Welfare League of America. • Generated and assisted other supervisors in generating complaint investigation reports. Social Worker (May, 1995 to March, 1997) • Provided case management services to foster children and support and problem-solving skills to foster parents. • Utilized crisis management with clients. • Liaisoned with other professionals (county social workers, physicians, therapists, and school staff) as a means of providing case management. • Ensured compliance with state and local regulations through weekly visits to foster homes. Educational Background M. M. F. C. C. (Master's degree in Marriage, Family, and Child Counseling), 1994, University of Southern California. G.P.A.: 4.0. Inducted into Phi Kappa Psi Honor Society. B.A., Psychology, 1992, University of Pennsylvania. G.P.A.: 3.1. Dean’s List,-.