Business owner for several cross-functional, Provider network/IT-related projects; responsible for improving operational processes, reducing Medical Loss Ratios, improving HEDIS and Star ratings and most importantly, improving the well-being of our members for a national leader in the managed Medicaid/Medicare industry. Also responsible for National contracting and management of several key vendor relationships.

Managed staff of ten FTEs who were responsible for the administrative functions related to managing the world's largest International provider network, catering to Expats. Responsible for Direct Provider Contracting, Provider Data Maintenance, working with IT staff to develop more efficient self-service solutions and overseeing provider healthcare delivery through an external vendor program (CignaLinks). Major Accomplishments:- As Business owner of the Provider Information Management System (PIMS), was responsible for the development of Functional and Technical requirements for the provider database. - Successfully implemented PIMS Phases 1 and 2, which resulted in an increase (from +16 to +35) in Customer satisfaction (Net Promoter Score) survey scores, and increased claims cost-savings as a result of discounted fees being more available to claims and clinical teams. - Implemented a Provider satisfaction survey, which resulted in increased NPS scores (from +8 to +18) as a result of the improved service that the Network and Operations teams provided to our contracted providers.- Have participated in Network Expansion and Integration efforts that have improved cost-containment results (through higher discounts and lower per unit costs) and improved cusotmer satisfaction by making 2,000 + more providers available worldwide.- Worked with IT to develop Functional requirements for enhancements to Provider Portal, enabling more self-service functionality for providers, which will further increase Provider Satisfaction and reduce operational costs for Cigna.

Directed staff of 13 FTEs who were responsible for creation of Denial letters for the Clinical Management team and responding to Appeal requests, all of which were required to be completed within very aggressive turnaround times as mandated by state regulations; and a staff of 3 FTEs who were responsible for responding to Complaints. Also responsible for the creation and revision of all corporate policies that pertained to all Utilization Management, Complaint and Appeal functions in a 13-state region.Major Accomplishments:- Managed staff of 13 FTEs who were responsible for researching, investigating and processing more than 1500 appeals per month for nation’s largest managed behavioral health care provider, and answering 300 + phone inquiries each week;- Significant contributor to Regional Office’s NCQA Accreditation Survey; awarded a three-year Full Accreditation with a perfect score of 100;- Assumed leadership of a team that was struggling with Compliance metrics at the mid 80 % level; and was consistently producing Compliance metrics at the 98 % - 99 % level when I left;- Collaborate with numerous internal functional partners (Clinical Operations teams, Account Management, Claims, Legal, Corporate Compliance, Physician reviewers) as well as External Customer contacts on a daily basis to resolve appeals and complaints on high-visibility cases; - Selected by VP of Compliance as an SME to develop a prototype application for forecasting and inventory management that was ultimately rolled out to all other regions within the company.

Directed staff of 24 FTEs responsible for installing New Sales, Renewals and Policy changes for Prudential’s Group Insurance (Life/Disability products) division; interacted with multi-functional areas (Sales, Accnt Mgmt, Billing, Claims, Underwriting, Contracts) to ensure successful installation.Major Accomplishments:Reduced operational turnaround time from 83 to 25 days by implementing people and process improvements while meeting budget each year;Achieved 92% satisfaction rate (Very to Extremely Satisfied) on surveys to internal partners;Selected by SVP to participate in Customer Experience Mgmt workgroup to identify, design and implement improvements throughout GI division to enhance our customer’s overall experience with Pru. Examples include improved Web technologies for enrollment portal, cross-functional training for front-line staff to improve interaction between departments, improved data available to Contact Center agents to increase First Call Resolution.

Managed up to 75 Customer Service Representatives, six CSR Supervisors, 10 Support Services staff members, and two Customer Service / Support Service Managers for key location of the nation’s largest managed behavioral health company. Also managed day-to-day operations (Mailroom, Facilities, Receptionist, Information Systems) for a 200-employee site generating over $125 million in annual revenues.• Awarded three-year full Accreditation by the National Committee for Quality Assurance (NCQA) in June of 2003.• Consistently met all quarterly performance standards for telephone responsiveness and customer satisfaction from 2001-2004.• Consistently met financial targets (Operating Expenses) each fiscal year (1999 – 2004).• Successfully managed over 10 transitions as provider network converted from sub-capitated to fee-for-service delivery model.• Completed successful move of 150 employees into expansion space, and managed renovation of existing space.

Managed Network Operations (facility and individual Provider Contracting, Credentialing, Profiling, and Relations) for six-state region. Supervised staff of four Network Coordinators and three Administrative staff members. • Consistently exceeded all performance metrics related to contracting, provider education / site visits, and provider satisfaction. • Selected by corporate Network Management Department to participate in several workgroups related to improving business processes and organizational profitability.

Sold and marketed stand-alone Employee Assistance Program (EAP) and Managed Behavioral Health (MBH) programs to employers, and Taft-Hartley Health and Welfare Funds.• Selected by President of company to participate in inter-departmental strategic planning workgroup to develop blueprint for company’s future.