Crafted and developed a diverse range of K-pop fan merchandise, including acrylic photocard holders and washi tape, to meet the demands of a niche market. • Managed end-to-end product development life cycle, fostering a dedicated customer base.• Successfully oversaw website sales, order fulfillment, and in-person events, gaining social media acclaim.

• Responsible for the execution of business transformation initiatives directly impacting the Claims Pay for Care Journey with the potential and probability for Enterprise engagement and support.• Served as Product Owner for initiatives with focus on simplifying our claims system UI, improving claims system user experience, and reducing administrative costs.• Provided consultation to define and achieve objectives, identify risk, and implement both technology & business-only… Show more • Responsible for the execution of business transformation initiatives directly impacting the Claims Pay for Care Journey with the potential and probability for Enterprise engagement and support.• Served as Product Owner for initiatives with focus on simplifying our claims system UI, improving claims system user experience, and reducing administrative costs.• Provided consultation to define and achieve objectives, identify risk, and implement both technology & business-only solutions.• Analyzed and documented business and user needs & ensured technical requirements and project plans were in alignment.• Ensured compliance with regulatory agencies and governing bodies, minimized risk to the business and ensured that operational and financial controls were effectively managed using compliance, risk, or internal audit methodologies and practices.• Created and managed requirements documents for large project initiatives including WebTPA and Continuity of Care• Established and managed Enrollment & Billing issues within the Pay For Care Journey and acted as the primary point of contact for IT for assigned initiatives• Ensured projects and outcomes met business objectives, KPIs, and metrics and that Operational Readiness plans were executed efficiently.• Oversaw progress of projects and coordinated with business leads to understand operational impact at initiative level by reviewing process mapping, business rules and user requirements.• Identified opportunities for transformational change to claims application and technology solutions.• Prepared detailed business analysis reports regarding HMO Member Liability and presented results to Executive Leadership Show less

• Obtained and analyzed data to resolve escalated internal and external customer issues by working with IT to determine root cause.• Tracked and communicated final results of issue resolution plans and status to both internal and external customers at all levels.

• Utilized enrollment processing programs to resolve enrollment, membership and billing issues across multiple products and systems including performing financial audits and resolved billing account balance issues. • Created effective written team communications and DTPs for multiple processes to include Suspense Cash Exceptions, Billing Recon Exceptions and Continuous Credit Balance inventory reduction projects

• Completed adjustments and held claims of BlueCard Home complex or escalated claims processing issues to include employee group, SAO, Worldwide, Med Advantage and NSA products.• As team lead for the finance open cash reduction project, ensured that agreed upon goals were met daily and reported to the appropriate leaders.

• Answered incoming provider calls regarding claim status and created service requests for any identified claims processing issues or interacted with other Blues Plans to resolve claims issues.

Supervised 4 dispatchers to insure that urgent after-hours messages were delivered in a timely manner and according to protocol outlined by physicians.