Christopher Murrie Email & Phone Number

• Oversaw efforts to reduce interest and penalty payments across various medical claims areas, including Medicare, Medicaid, and Commercial, developing strategies and process improvement initiatives to minimize interest.
• Led a specialized team in identifying opportunities for interest and penalty reduction on claims utilizing advanced data collection methods to analyze and interpret process issues, performed root cause analysis, and.
• Conducted internal audit reviews for key functional business areas to support ongoing operational excellence working with different departments, including Claims Operations Provider Connectivity, Market, Contract Load.
• Directed Claim Interest & Penalty projects aimed at controlling costs, reducing expenses, and ensuring regulatory compliance.
• Executed leadership and development initiatives to ensure quality assurance and drive performance and efficiency improvements.
• Developed and implemented auditing processes to enhance claims processing, enrollment/disenrollment activities, appeals, grievances, and customer service accuracy.

• Decreased yearly Interest and Penalties from $30M - $12M in 3 years
• Prevented $30M in interest payments in 3 years
• Increased Associate engagement scores from 60% to 98%, reducing employee turnover by 20%
• Developed new analysis decreasing late payment interest by 27% and lowering correspondence interest by 14%
• Crafted processes and procedures leading to increased knowledge and decreased rebuttals by 39%
• Developed procedures to identify errors and operations impacts 3 weeks earlier

• Oversaw daily operations and performance of the claims team supporting the Medical Claims Operations by peer reviewing claims of up to $1M for all Medicare and Medicaid members under Humana.
• Managed an annual claims department budget of $3M, ensuring all expenses were within 5% of the budgeted amount, and identified cost-saving opportunities within the department, leading to a 12% under-budget performance.
• Directed a dedicated team of 6 Humana claims associates and 35 offshore vendor claims associates (Sagility/Conduent) within the claims service operations environment, focusing on mentoring, development, and employee.
• Collected and verified information from internal and external sources to ensure the completeness and validity of claims, including coordination of benefits.
• Partnered with claims operations leadership (Operations, Front end claims, initial claims, Corrected Claims, CRU) on projects to identify gaps in benefit and claims configurations, uncover root causes, and establish.
• Monitored daily inventory, operational front-end issues, vendor key performance indicators (KPIs), and service level agreements (SLAs) and provided feedback on procedures and special projects.

• Championed an enhanced high dollar review process, decreased late payment of claims by 60%
• Developed a high-dollar data reporting system that increased claims processing accuracy by 20%
• Refined STRATA review process, increasing rebuttal success rate by 6.2%
• Developed forecasting and labor allocation strategies, adapting to changing conditions to support cost control and meet business requirements while exceeding quality performance standards.

• Reviewed and investigated all Medicare and Medicaid claims up to $100K for accuracy, analyzed claim errors, determined root causes, adjusted claims, identified system issues, tracked trends, and submitted requests for.
• Investigated, analyzed, and resolved issues within the internal claims reimbursement system, correcting invalid financial recoveries that affected payment accuracy.
• Interpreted complex Employer Group Business claims, focusing on performance guarantee employer groups with complex state and government regulations.
• Collaborated with the CAS BSS to research claim processing logic and various systems to verify the accuracy of claim payments, member eligibility, and billing/payment status.
• Coordinated discussions on claim accuracy across multi-disciplinary tasks, audited claims for pre-payment adjustments and researched claims reviewed by offshore claims teams for final adjustments and payments.
• Contacted members to obtain additional information, such as medical records, proof of payment, and hard copies (CMS1500, UB04 forms), to facilitate the release of payments or denials.

• Enhanced invoice validation process, resulting in a $30K credit
• Developed CAS Macro project, increasing production by 15%
• Cultivated 3rd-party administer relationships, resulting in a 10% improvement in claims processing accuracy and an 8% reduction in processing timeframes
• Conducted comprehensive root cause analysis, leading to a 25% reduction in recurring system issues within the claims department

• Investigated, analyzed, priced, and adjusted resubmitted Medicare and Medicaid claims from physicians and hospitals based on federal register fees, flat fees, percentages, or pre-set rates by contract, including.
• Managed ongoing claims for an assigned caseload, including capturing medical information, applying contractual provisions, following legal guidelines, and utilizing expert resources.
• Analyzed, priced, and adjusted claims from physicians and hospitals based on federal register fees, flat fees, percentages, or pre-set rates by contract, including coordination of benefits and pre-existing condition.
• Adjusted medical claims submitted by Medicare-contracted physicians, verifying contractual agreements using various systems and tools, including Argus, CCP2, GCP, Benefits, and Physician Finder Plus, to achieve claim.

• Assisted in training, improving team performance and reducing onboarding time by 15%
• Developed spreadsheets for determining anesthesia calculations, stop-loss logic, payment calculations, ambulance calculations and normal liability, resulting in a processing time decrease of 50%.
• Created reference tools for adjusters to enhance the efficiency and accuracy of medical claims adjudication.

• Addressed and resolved member inquiries related to Medicare and Medicaid benefits (HMO, PPO, PFFS, Med Sup), claims, and pharmacy services, maintaining high standards of customer service and satisfaction.
• Delivered comprehensive overviews of healthcare benefits programs, educating members on cost-effective strategies to maximize their benefits and minimize expenses.
• Investigated claim discrepancies and coordinated resolutions with plan administrators, ensuring thorough documentation of all interactions, customer service activities, and outcomes across multiple systems.
• Verified caller identities in accordance with HIPAA guidelines to ensure compliance with healthcare regulatory policies and procedures, aligned with state and federal regulations.
• Delivered high-quality customer service by diagnosing issues across various platforms, including Argus, CCP2, GCP, Benefits, and Physician Finder Plus, and provided feedback to management to prevent future or recurring.
• Supported tenured agents and new hires by providing assistance on helplines and team chats, helping develop representatives through quality scoring and coaching, and ensuring optimal performance.

• Consistently maintained ECHO scores above 4.5, contributing to the department’s top performance metrics.
• Ensured all calls were processed in compliance with Medicaid/Medicare regulations, achieving a 100% compliance score during audits.

• Part of the pre-injury team in the largest workplace rehabilitation company in South Australia, managing a caseload of up to 33 clients.
• Identified appropriate rehabilitation strategies through consultation with medical and allied health practitioners, assessed workplace injuries (both physical and psychological), and made return-to-work recommendations.
• Assessed suitable vocational options for clients and provided vocational counseling, reviewed various worksites, and made recommendations to decrease workplace injuries.
• Continually performed in the top company percentage for positive outcomes, case duration, and billable targets.

Human Movement

Certificate 4 And Diploma, Parks, Recreation, Leisure, And Fitness Studies