Hired on to oversee a team of business analysts, as well as supervise teams in supporting new contracts. Led cross-functional initiatives to design and implement operations for state, federal, and commercial contracts.Standardized the requirements gathering and approval process, as well as workflow mapping, and user-acceptance testing improving efficiency and accuracy of systems configuration.Implemented state Medicaid programs including North Carolina, Alabama, West Virginia, and Colorado (a multi-phased, 11-month implementation).Enacted strategies and roadmaps to standardize enterprise operational capabilities that enhance current and future products and solutions, and accurate assessment of work efforts, resource allocations, and implementation timelines leading to positive ROI.Developed strategies and roadmaps to standardize enterprise operational capabilities to enhance current and future products and offerings.

Recruited to be the Site Leader for East Region, ensuring compliance with OSHA and ADA requirements ensuring building and staff safety, ensuring exceptional service and support for comprehensive independent medical evaluations (IME) and other related services for veterans. Responsible for 200+ staff in multiple locations and time zones. Managed relationships with external partners and vendors. Participated in internal and external audits.Streamlined processes and workflow increasing productivity by 22%.Modified training program and document management protocols, increasing quality scores 17%.Developed program to identify veterans in the same geographic area to practitioners, increasing scheduling success rate 25% by offering volume appointments.Reduced staffing needs by 10% by increasing productivity, implementing process improvements, and prioritizing automation.

Spearheaded oversight of the CORE administrative system configuration of Health Plan Services clients. Managed multimillion dollar budget with 10 direct reports and department of 250+ team members. Oversaw Claims Inventory, Claim Audit, Claim Payment, and Overpayment Recovery functions. Enabled on-time adjudication of claims for Health Plan Services received from contracted and non-contracted providers. Collaborated with executive leadership and the Implementation Team and Configuration Team.Reduced company liability for errors and omissions by 10% in the first three months and reduced total claims adjudicated 30+ days from 35% to 10%.Introduced inventory management protocol, reducing liquidated damages and interest penalties due to untimely payments by 40%.

Leveraged professional experience and knowledge to consult on solutions to support unique product needs, industry processes, regulatory requirements, and other emerging needs. Defined strategic direction and oversaw teams. Provided consultative, design, and implementation services for technical solutions. Developed customized solutions for unique products, industry, business and management processes, regulatory requirements, and other business needs. Modified methods and procedures to create possible alternative solution for client problems. Determine methods and procedures on new assignments. Helped define strategic direction as it relates to team and client goals. Managed teams and work efforts.Health and Public Service National Insurer - Supervised organized labor employees, managed claims inventory, and completed migration testing during transition to new system, enabling migration. Maintained RACI and Traceability matrices, RAID log, developed and coordinated user acceptance testing plans. Developed and presented executive reports for status and risk management activities, and testing results.Public Exchange Participant - Functioned as Project Manager and led command center activities during client's migration to new core administration system. Supervised business analysts to achieve goals. Developed and managed project plan and task completions. Maintained RACI and Traceability matrices, RAID log, developed and coordinated user acceptance testing plans. Developed and presented executive reports for status and risk management activities, and testing results.National Pharmacy Benefit Management Firm - Acted as a Project Manager and command center support for $29B merger, resulting in projected productivity gain of 38%. Lead command center activities during system cut-over. Developed and managed project plan and task completions. Maintained RACI and Traceability matrices, RAID log.

Co-founder of network management organization managing data, contracts, claims routing, and repricing services for rental and proprietary PPO and HMO networks. Established the Claims and Training departments, and Quality Control program, at a technology startup that determined eligibility and negotiated rates for proprietary and national PPO and HMO contracts. Oversaw 350+ staff in multiple locations and time zones, including offshore staff.Developed infrastructure and processes with ability to scale claim volume from 10 claims per day to 53 million annually.Created workflows to maintain service levels of 98% of all claims finalized within 24 business hours.Developed and implemented enhancements reducing appeal inventory and decreasing turnaround time from 180 days to 10 business days, improving client scores from 43% to 85%.Established automated provider data loading processes with a load rate of 97%.Develop repository, process flow and procedures to manage and resolve escalated appeals, disputes and Department of Insurance complaints. Represented MultiPlan in disputes involving legal actions and arbitration hearings.Investigated HIPAA violations and implemented remediation activities.Managed team to negotiate balance-bill discounts for out-of-network claims and claim, patient, and episodic specific agreements.Co-created proprietary provider data management database used to maintain data from rental and proprietary networks:- Established automated provider data loading processes with a load rate of 97%.- Created provider load and standardization rules and processes to identify and eliminate duplicate provider records necessary for automated provider selection for claims processing.- Defined claim workflows to support product, client configurations, corporate and regulatory standards to ensure accurate provider and contract selection for claims repricing.

Managed day-to-day activities for inventory management in support of provider demographic and contract data required for claims adjudication - Hire, mentor and train staff - Ensured accuracy and timeliness of demographic updates - Ensured compliance with company and client standards and service level indicators - Developed procedures, workflow and incentive programs increasing productivity by 35% - Reduced 4 month update back-log to turn-around-time of 72 hours - Reduced FTE and expenses by 25% - Partnered with Human Resources to establish company temporary work pool eliminating the need for temporary agency support and fees - Increased team quality by 3 percentage pointsAdditional CIGNA Positions:-Claims Manager-Policy and Procedures Consultant-Training and Communications Specialist-Senior Quality Control Analyst-Claims Adjuster