Responsible to facilitate the relationship between the site operations and Account Management and/or Implementation personnel/select external client personnel. Assess the quality, consistency, and satisfaction of services delivered. Act as a consultant in ongoing client relationships to ensure retention of the client and resolution of service issues. Interface with Implementation and/or Migration personnel and account management to ensure that mail order programs set up for new and existing clients are functioning according to optimal service standards.• Work with account management and the client to develop strategies for client issues as a result of service failures in order to meet client expectations and return to satisfactory service levels.• Ensure site operational readiness regarding the implementation of select new clients.• Act as the central focal point for resolving operational issues during start up and manage the service levels to meet the expectations of the client.• Provide trend analysis and direct service recovery initiatives where warranted.• Primary contact for resolution of daily service issues presented by Account Management staff and/or select external client personnel.• Interface with Implementation and/or Migration personnel and account management to ensure that mail order programs set up for new and existing clients are functioning according to optimal service standards.• Coordinate client site tours with account management and site personnel and provide operational data and slides as needed for the presentation.• Ensure operational readiness regarding the implementation of new clients and manage the service levels to meet the expectations of the client.• Develop work plans when needed.• Update the work plan and communicate the status of the work plan with the appropriate parties.• Adhering to quality and production standards while complying with all applicable company, state and federal programs and procedures.

Primary contact for daily account activity and operational needs for issue resolution in eligibility, claims, implementations, participant materials, report requests, and general inquiries for complex claims. Assist in reviewing quality control of account activity, operations, tracking operational performance guarantees and maintaining documentation for client review. • Drives issues to resolution independently, engaging leadership and stakeholders appropriately to ensure visibility and collaboration. • Management of the development and documentation of procedural guidelines which clearly outline how tasks are managed from end to end. • Orchestration of collaborative client sessions to ensure requirements, timelines, and agreed-upon expectations and guidelines are established for managing project/initiative outcomes.• Accountable for proactively sharing best practices and lessons learned with team or other stakeholders.• Leader in identifying and resolving training and mentorship opportunities for team members.• Developing and identifying key steps to remediate issues, and independently creates action plans to move resolution forward.• Driving strategic initiatives which help identify process improvements to better client/customer relations, as well as day to day activity.

Responsible for ensuring that as a trusted advisor to the client, requests and issues are acknowledged, tracked and resolved in a timely manner according to client contractual requirements or CMS guidelines. Efficiently and effectively communicate client requirements and issue details to internal partners and facilitate, track, collaborate, and manage resolution to ensure all parties’ needs are met. Specific areas of accountability include:•Drives oversight and validation of Client regulatory reports to meet CMS timeliness, accuracy and submission guidelines. •Management of the development and documentation of procedural guidelines which clearly outline how tasks are managed from end to end. •Business Lead for 1/1 client benefit renewal/implementation (Annual Enrollment Plan – AEP)•Orchestration of collaborative client sessions to ensure requirements, timelines, and agreed-upon expectations and guidelines are established for managing project/initiative outcomes.•Accountable for operational reliability of internal processes supporting the contractual client requirements and service level agreements for the Medicare Part D product.•Subject matter expert for initial analysis of issues to determine root cause and triage to internal areas of accountability.

Responsible for management, oversight, development, and process improvement activities for the following Medicare Service Products: CMS Regulatory Reporting, Explanation of Benefits (EOBs) and Transition Letter processes. Specific responsibilities included:•Oversaw the monthly product requirements coordinating with account managers, Compliance, IT, Data Analytics, and internal partners to ensure accuracy of report development, testing, and delivery of monthly deliverables.•Managed annual changes to the CMS Required Reporting guidance, facilitating requirement documentation, user acceptance testing, communicating changes with IT, internal partners, and clients, and developing a delivery schedule.•Directed the Medicare Benefit Annual Enrollment Period Readiness (AEP) pre and post testing activities to ensure all development and operational functions to support CMS & Client compliance requirements were accurate and compliant for the Transition and EOB products.

Responsible for the tracking, developing and maintaining of all reporting data required by CMS, on a monthly, quarterly, and yearly basis. The management of the explanation of benefits (EOB) process to ensure timely delivery to the membership, including identifying areas of improvement to enhance the timetable of EOB deliverables. Specific responsibilities included:•Coordinated collaborative requirement gathering sessions to ensure the development teams captured all requirements and worked with IT to assist in translating and identifying system design changes necessary to support the requirements.•Collaborated with the IT and Analytics development teams supporting the generation of CMS regulatory reports, reviewing and validating all monthly draft and final reports. Disseminated approved drafts to internal account managers for distribution to clients. Assisted with research of all issues concerning the reporting.•Managed the design, development and implementation of the CMS reporting tracking database, which identifies when reports are due to the Client account managers, and compilation of that information for oversight reporting required for supporting auditing requirements for the Compliance team and executive leadership

Responsible for managing, developing, and training process improvements created from issues identified by any given area within senior business. Primary business areas supported included customer service, eBusiness, and training. Supported all business departments by participating in projects, process workflow and implementations. Essential duties include, but were not limited to:• Facilitator and coordinator of meetings, and process improvement initiatives to insure clear communication of changes and to attain buy-in from all necessary departments and teams.• Creation of process flows, standard operating procedures and technical requirements for all business units.• Researched operations workflow problems and system irregularities; developed, tested, presented process improvement solutions for new systems, developed and led project plans and communicated project status; provided process direction and decision making for all minor and major project work; provided guidance and mentoring to process experts.