Senior Manager, Process Optimization
CurrentDeveloped teams responsible for process optimization of grievance, appeals and utilization management workflows. Accomplishments include the below.- Created monthly data insights reporting on grievance and appeal drivers. Trend analysis on member pain points contributing to grievances and (overturned) appeals was used to develop initiatives for improved member experience and subsequently reduce grievance and appeal inventory.- Partnered with tech teams to consolidate and redesign grievance and appeal analytics dashboards for increased visibility into operational health by production teams and executive leadership.- Conducted root cause analysis to identify drivers of avoidable provider claim escalations. Leveraged findings to develop claims training for provider team, bridging knowledge gaps to improve team's ability to self service provider claims questions, increase speed at which provider issues are resolved and reduce escalation inventory.- Implemented cross functional workgroup to improve document triage, reducing delays related to workflow bottlenecks, processor variation, and tooling gaps such that appeals are processed efficiently and risk of missed regulatory deadlines is mitigated.- In partnership with Utilization Management production teams, revamped utilization management workflows for DRG facilities to reduce avoidable concurrent review inventory. Collaborated with technology partners to update tech tooling to increase ease of use and decrease workflow variation.
