Corey Shaw Email & Phone Number

Saint Louis, Mo, Us

Constructed a Claims Experience strategy from the ground up focused on improving member, provider and employee experiences in critical moments across the claim lifecycle. Developed the Provider Effort Index (PEI), a new key performance indicator to reflect how much effort providers encounter within the claim lifecycle. PEI presents a strategic level of aggregation across markets and lines of businesses, as well as tactical detail to drive data insights into action. Developed and launched a market adoption strategy focused on driving accountability across Centene’s 30+ health plans. Partnering with Availity to implement multiple products focused on driving a better healthcare provider experience. The Essentials product is a provider/payer portal offering greater visibility & transparency, allowing for increased self-service. The Claims Editing product is focused on bringing forward provider pain points across the claim lifecycle (i.e. Denials), allowing for a faster provider revenue cycle.

Directed the Billing & Enrollment (B&E) workstream for Author by Humana (AbH) – a startup to build a health plan of the future, initially focused on Medicare (MAPD) plans. Synchronized efforts across matrixed internal cross-functional teams and external vendors to stand up technology infrastructure, business processes, operational support and a service model focused on delegation with Core Humana enterprise teams. Service model resulted in NPSt of 79 for B&E interactions (scale of -100-100; 2021 Health Insurers industry avg 13.5 according to Forrester). Stood up B&E Call Listening program to champion continuous improvement. Operated as a business owner within the SAFe Agile Framework. Participated in PI and Big Room planning sessions, partnering with product teams to drive solutions forward. Served as data steward for all membership data transactions. Post startup launch, I transitioned to support scaling efforts for Business Process Management, Project Management and Operational Efficiencies across AbH’s Service Operations (workstreams including B&E, Claims, Grievances & Appeals, Provider Contracts & Pricing and System Management Support). Utilizing consumer and associate feedback to continuously improve MVP products including CRM (Sugar) and Claim Adjudication (Health Rules Payor) systems within SAFe Agile Framework. Scaling best practices from B&E Call Listening program to encompass all operational workstreams. Working cross-functionally to redesign Issue Intake & Management and establishing metric dashboards for Operational and Senior Leadership consumption.

Louisville, Kentucky, Us

Set vision and strategy for the Claims Cost Management (CCM) Service teams for Financial Recovery, Special Investigations and Subrogation contacts as well as process design and strategic project management. Transformed healthcare provider B2B experience through Omni-channel contact approach, including a Service Recovery process focused on improving negative experiences. Collaborated with internal IT & external vendors to develop intuitive products focused on increasing self-service and driving adoption. Developed voice of the customer (VOC) surveys to gauge satisfaction, effort, and issue resolution across a variety of channels. Leveraged VOC results to identify optimization opportunities and develop action plans to eliminate customer pain points. Established CCM Call Listening program to help non-customer facing teams gain customer insights. Maintained Customer Satisfaction of 86 (scale of 0-100; 2019 Health Insurance industry avg 74 according to ACSI), Customer Effort Score of 3.2 (scale of 1-5) and established Provider based NPSt goal for 2019 deployment (scale of -100-100; 2018 B2B Insurance industry avg 20 according to ClearlyRated). Established capacity planning for calls & non-call functions. Advocated for and partnered with quality audit teams to transform audit programs from transactional to experience focused.

Louisville, Kentucky, Us

Directed the CCM post payment medical claims audit for Commercial, Medicare and Medicaid lines of business, resulting in $600-$700M overpayment setups annually. Established monthly capacity planning to predict full time employee & vendor staffing needs. Drove insights into action by establishing operational efficiencies, including process controls, inventory management controls and RPA (robotic process automation), leading to cost avoidance of $5M+ over span of two years.

Louisville, Kentucky, Us

Led the Service Quality Organization (SQO) Operational Support team focused on metrics and analytics, learning facilitation, and sampling methodologies. Guided Lean & Six Sigma Green Belt projects. Directed Baldrige Level II & III certifications via KYCPE focusing on 1 Leadership; 2 Strategy; 3 Customers; 4 Measurement, analysis, and knowledge management; 5 Workforce; 6 Operations; 7 Results.

Louisville, Kentucky, Us

Established and managed relationships within matrixed internal cross-functional teams and external clients. Coordinated end to end program from the point of sale to members loaded in system, ID cards issued, claims opened for processing and certifications issued. Focused on customized ASO and high-profile clients across multiple markets.

Louisville, Kentucky, Us

Louisville, Kentucky, Us