As VP of Operations, I champion strategic visioning and leadership of GEHA’s Claims, Appeals, Enrollment, and other health plan operations, directing a total workforce of 500 in the seamless execution of claim operations roadmaps. In this role, I manage the overall financial performance of the business unit, including preparing and allocating an annual $30M operational budget, developing monthly projects, and driving efforts to achieve profitability targets.Key Achievements•Continuously innovated solutions that enhanced member engagement and satisfaction, leveraging best practices, data, and technology to drive claims process automation and optimization.•Reduced claims denial rate from 13% to 10% annually, which minimized adjustments as well as provider inquiries.•Launched a corporate risk assessment guide for strategic claims and cost containment projects valued at $110M.•Recruited and developed strong talent across Claims, Appeals, Enrollment, and Business Operations departments, cultivating top-performing teams recognized for exceeding operational and customer expectations.•Fostered collaborative partnerships with cross-functional stakeholders to drive financial and operational value across GEHA health plans, maximizing benefit coverage while containing cost.•Compiled, analyzed, and reported data providing actionable insights into key performance trends, regularly presenting call center and member satisfaction reports on behalf of senior leadership and the Board.Related

Manages Contact-centers with over 300 representatives in multiple sites across the United States and India.Responsible for performing QA of correspondence, adherence to defined processes, and member retraining and reportingLeading, coaching, and developing staff at all levels to achieve high performanceEffectively communicating with internal and external stakeholders, including government or commercial clientsWorking with other Directors and Managers and team leads at various locations, to create a cohesive and collaborative environment that values team success across delivery, quality assurance, training, communication, and reportingSetting member goals and objectives and performing quarterly and annual member performance evaluationsEnsuring large volumes of assigned work is completed accurately, and timely, in accordance with Service Level Agreements (SLAs), and in adherence to Standard Operating Procedures and the Statement of Work (SOW)Defining KPIs, key metrics, and perform data analysis in MSFT/Excel and other software knowledge for analyzing team performanceLeads continuous process improvement and Lean management efforts

In my role as Director of Consumer Experiences, I established and directed a call center with potential growth to over 100 representatives, leading the ideation, development, and launch of innovative customer experience plans.Throughout this time, I headed all facets of call center operations, quality, and compliance, continually analyzing customer satisfaction trends – such as voice of customer (VOC), transactional surveys, and NPS – to implement process optimizations.Related

During my tenure as Director of Operations, I presided over a Project Management Office with direct accountability for Retail Service Operations, leading a team of 125 direct reports across billing, enrollment, outbound confirmation, grievance/appeals, and other call activities.In this capacity, I drove performance augmentation by implementing and streamlining workflows, conducting compliance and risk assessments, and maintaining compliance with best practices as well as state and CMS regulatory requirements.Key Achievements•Decreased waste, improved yield, and substantially enhanced customer satisfaction by effectuating Lean operational procedures, including introducing dashboards that communicated key operational metrics to all stakeholders.•Enhanced NPS from 22 to 33 in one year by creating reports that measured and implemented service improvements.•Pioneered improvements to the Pharmacy Call Center such as implementing a Data Analytics team as well as coordinating with call center managers in integrating pharmacy process and procedure improvements.•Established a Program Management Office that streamlined operations for the management of over 50 projects.Related

In this role, I directed strategic planning, staffing, administration, and financial execution of call center and vendor operations for the company’s Kentucky market, leading four direct reports with a total oversight of 200 associates.Key Achievements•Delivered a 25% decline in repeat calls by intensifying call standards and increasing first-call resolution.•Cut the average handling time by 40 seconds by recognizing nonproductive wait time and upholding strategies that ensured first-rate customer service.Related

As Director of Claims Operations, I spearheaded corporate, divisional, and organizational strategies, including defining long-range goals, managing an annual budget of $30M, and directing a total workforce of 400 associates.In doing so, I directed inventory management of 500K+ claims each month that accounted for 75% of Humana’s commercial claim payments, ensuring timely and quality processing through associate accountability.Key Achievements•Managed outsourced operations of on- and off-shore vendors, including in Indonesia and the Philippines, confirming vendors met metrics that rolled into internal projections and reports.•Increased production of the Claims Rework Unit by 50% as project leader for the Claims BusinessContinuity Plan.•Achieved 90th percentile results from employee engagement and leadership assessment surveys(Kenexa), attending conferences and speaking to Humana leaders on approaches and styles that create positive employee experiences.•Regularly presented quality status to executive-level leaders, managers, and provider representatives, delivering results and recommendations for future optimization.Related