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 payments. • 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 audits to drive operational and process improvements.• 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, Prepay, Post Pay, Compliance, Financial Recovery, Claims Cost Management, Provider Load, legal, CAS BSS, MTV BSS, CIS load, G&A, Coding, and Front end.• 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. • Conducted root cause analysis on multiple claim processing platforms to ensure accuracy and address deficiencies identified during Compliance, Internal Audit, QAP assessments, and Regulatory Audits. • Conducted risk pool audits to evaluate claim payment efficiency in accordance with Texas Department of Insurance (TDI) specifications. • Provided peer review G&A, complaints from the state and Executive requests to determine applicable interest.• Analyzed audit data to identify and report trends among in-house and off-site/telecommuting staff and provided analytical insights into daily operations.

• 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• Led the design and deployment of a new reconciliation process for regulatory cases, reducing the risk of monetary penalties for late responses. • Developed the quarterly TDI RiskPool process and reported achieving 100% compliance with state and federal regulations and quarterly annual audits, avoiding potential fines and penalties.• Managed budget reconciliation of $40 million, ensuring all expenses were within 4% of the budgeted amount.• Revamped the review process to provide further insight into what late payment and correspondence interest were present and how errors were assigned to a department.

• 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 without compromising service quality.• 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 retention. • 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 effective solutions to align operations with growth objectives.• 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.• Evaluated individual and team performance to identify areas for continuous improvement to enhance customer experience and increase engagement. • Conducted team onboarding, professional development, and training, including providing support to end-users on Humana systems, including CAS, CCP, Macees, and Ehub, to ensure the delivery of exceptional customer service. • Trained associates on the correct processing of claims impacted by member cost-sharing and authorizations, resulting in improved audit scores.• Developed claims workflows and SOPs to ensure accurate claims service adherence to processes and ensuring compliance with state and federal laws and regulations.

• 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 claims to be reprocessed.• 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.• Collected and analyzed data to identify areas for improvement in claims processes, developing action plans to address identified issues. • Collected data for denial determinations, acting as a subject matter expert on unit workflows, fiduciary responsibilities, and appeals processes.• Developed and managed Impact to Operations meetings, enabling Claims Operations to address any operational impacts and resolving issues prior to go-live dates.• Participated in a testing team for the implementation of a new claims processing system, providing weekly feedback and suggesting enhancements to the system.

• 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 coordination of benefits and pre-existing condition determinations in accordance with plan provisions, Medicare, and Medicaid.• 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 determinations in accordance with plan provisions, commercial (POS, PPO), Medicare, and Medicaid.• 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 resolution.

• 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 issues.• 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.• Managed escalated calls requiring on-the-spot decision-making, collaborating with other departments and supervisors to achieve the best outcomes for customers.

• 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