Claudette Watson Email & Phone Number

Woodland Hills

Provide compliance oversight and policy guidance for Covered CA and other major Commercial contracts to ensure regulatory and contractual obligations are met.

Woodland Hills, Ca

Communicate new and revised laws and regulatory guidance that affect the business unit and interpret/summarize the requirements. Collaborate with the business unit to review, analyze and oversee regulatory implementation project plans, including gap analysis, communication and training, action plan deliverables and development/revision of policies and procedures.Consult with the business unit on developing and implementing compliance controls and quality measures.Support business unit in establishing policies, procedures and best practices that promote compliance with applicable laws and regulations. Perform a compliance review of proposed statements of policy and procedures.Monitor business unit’s performance to validate business unit self-audits. Proactively test processes against regulatory requirements. Report results to business unit and Compliance Department.Develop Corrective Action Plans in response to identified deficiencies, track progress, and communicate status of corrective actions to the business, Legal and Compliance Departments.Provide input and guidance in development of marketing campaigns and member materials to ensure compliance with regulatory requirements.Monitor business unit's escalation activities to ensure potential compliance risks and suspected or confirmed compliance issues are escalated to appropriate business units.

San Dimas, Ca

My responsibilities include:  Management and oversight of the compliance and operational performance of the Enrollment Department. Including the monitoring of regulatory activities to maintain compliance for day-to-day enrollment business overseeing 12-15 employees/analysts. Managing the fulfillment of member materials and correspondence for 70,000 members in accordance to Medicare Marketing guidelines. Responsible for interacting with IT to define system requirements and upgrades mandated by Centers for Medicare and Medicaid Services (CMS).Ensuring the ongoing optimization of team productivity, quality, and compliance to deliver a best-in-class membership experience. Responsible for monthly, quarterly and annual reviews. Set expectations, measured results, and provided continuous formal and informal constructive feedback to team members.Facilitate special projects and daily workflow management which includes the maintenance of policies and procedures to ensure that staff is properly trained to meet updated compliance requirements.Responsible for vendor management and vendor pricing negotiations. Determine fiscal budgetary recommendations and reconcile monthly budget to ensure goals are maintained. Identify and make recommendations to eliminate redundancies, inefficiencies and inconsistencies in processes, reports, and workflow. Prepare Enrollment management reports for Senior Management and the Executive Team.

Camarillo, California

Deliver insight, technical expertise and organizational leadership essential to achieve key performance objectives for Medi-Cal and Medicaid claims processing for 340,000 State Sponsored members. Analyze workload; develop and monitor budgets and staffing requirements. Design and institute policies and procedures to optimize efficiency and quality. Communicate across departments to fully assess training needs. Develop, guide and oversee 40+ employees in customer service, claims adjusting and processing. Troubleshoot problems and implemented business process improvements which increased productivity by 20% and reduced turnaround times by 15%.Maintained reimbursement levels; reviewed new methodologies and payment mechanisms that improved results for cost containment Optimized performance for claims inventory, accuracy and turnaround time. Consolidated claims queues from 380 to 40 resulting in a 16% improvement in processing efficiency, and developed simplified workflows and procedures. Participated in successful strategic planning, budgeting, and system needs analysis during redesign of the proprietary claims automation system.

Downey, California

Oversight of the daily performance of 25-30 union claims adjudication employees to ensure accuracy and timely completion of tasks. Provided on-going training, authored annual performance reviews to identify issues and improve employee skills, and ensured processes and procedures were met or exceeded. Facilitated regular meetings with claims staff and monthly sessions with Contracting, Provider Relations and Case Management divisions that assured business continuity.Effectively created and facilitated labor/management collaboration and cooperation among diverse groups and departments in a union environment.

Los Angeles, California

Managed over 30 customer service professionals and claims processors in a call center environment, in addition to overseeing the Research and Correspondence team. Assigned work and monitored performance to meet team objectives. Provided quality training, feedback and support. Processed payroll and maintained compliance with corporate human resources policies.Handled 6,000+ calls daily and 1,500 pieces of mail weekly; supplied training and motivation that boosted team productivity 20%.Trained 200+ entry-level Customer Service Professionals. Provided developmental coaching of staff to achieve average productivity rating of 85%. Designated as part of the knowledge transfer team; traveling across the country to collect data and processes to transition work to the Los Angeles personnel.