Carol Culver Email and Phone Number

Operational support and process improvement for HealthCare Management including the UM, CM and DM teams.

• Supervison of the Claims Staff which includes the quality auditors, adjustors, trainers and market conduct staff.• Development and maintenance of unit policies, procedures and guidelines.• Responsible for goal setting, coaching, motivating and development of staff.• Developed and ensured compliance of performance metrics for the claims quality auditors.• Ensured departmental quality assurance standards and state statutes are adhered to through quality auditing.• Accessed and oversaw training needs in development of Customer Service, Claims Processors and other the Dental Claims Support Staff.• Responsible for programs which ensured the continued development of the Dental Claims Department• Personnel administration including time keeping, performance appraisals and continued growth• Collaborate with other departments to identify opportunities for improvement• Ensured adherence to State and Federal Regulations as well as Service Level Agreements for Key Clients

• Financial / Statistical Analysis and reporting for all projects in the Portland Design Center • Revenue and Expenditure Forecasting, Planning and Recognition• Project budget planning and analysis • Project cost tracking and analysis • Preparation of cost models and project budgets • Ensured continual project funding by analyzing, preparing and assisting with the incorporation of engineering change orders• Maintained cost and schedule baselines on all projects• Generation and analysis of profit and loss for each project• Generated, tracked and analyzed project expenditure reports• Tracking of resource utilization• Assisted Project Managers in collection of outstanding cash receipts• Advisor to the Project Managers • Liaison between the Project Managers and Corporate Finance • Provided analysis on all projects to ensure GAAP compliance• Created and presented financial data and reports to executive management

• Supervised 25 to 30 patient services representatives• Managed the daily operations and administration of Kaiser Permanente’s Dental Appointment Call Center• Established and measured departmental performance goals• Analyzed daily and monthly statistical data• Managed Project staffing needs and workloads, developed and maintained staff schedules• Recruitment and training of new employees• Liaison between the Dental Clinics and the Dental Appointment which included problem resolution to insure optimal patient care

• Supervised Customer Relations Representatives• Forecasted call volumes and staffing requirements • Responsible for recruiting, hiring, terminating and overseeing the training of new and long term Customer Service Representatives• Initiated the implementation of an incentive program for rewarding team members• Staffing schedules• Responsible for the overall coordination and supervision of all written benefit inquiries and complaints to insure a satisfactory outcome to both the Dental Professionals and the insured members• Provided assistance to the Information Systems Department in the development of several programs to improve customer service efficiency• Provided customer and provider education in the areas of managed care and benefit administration