> Responsible for accurate and timely group installation, enrollment and premium billing for dental, vision, medical and life products, including Key Accounts.> Effectively manage accounts receivable within company goals. Perform reconciliations of premium payments to identify discrepancies and follow through to ensure outstanding balances are collected and resolved.> Act as a customer advocate to provide assistance, build and sustain positive relationships with brokers, their customer groups and dedicated employer groups to resolve issues/problems. Proactively resolve issues and coordinate internal resources to ensure timely turnaround and proper corrective action steps are taken. Participate in client site visits, when necessary.> As Team Lead and Subject Matter Expert, provide guidance and mentoring to Group Administration team on complex enrollment and billing issues. Responsible for assisting with department training and process improvement.> Effectively support operational goals through ongoing partnership with Sales, Marketing, Underwriting, IT, Compliance to ensure a high level of service delivery.> Ensure department deadlines are met. Serve as back-up to Department Supervisor.> Provide direction and support to IT project team in developing new online functionality in the Solstice Marketplace. Understand and define business requirements and translate them into specific software requirements for development.> Identify the need and work to develop new reporting.> Have strong technical skills, business intelligence, and a full understanding of the needs of the customer and able to effectively communicate with internal teams and external clients. Being an interface between technology teams, support teams, and business units.

> Direct financial strategies and activities for UHC’s Life and Disability and Dental products. Manage teams for both product lines.> UHC’s life and disability product billing and revenue collection of $115M in annual premium and for paying $7M in annual commission.> UHC’s dental product paying $19M in capitation and $10M in direct compensation provider payments and $12M in vendor payments.> Responsible for the migration of the Association life/disability product from the Facets 4.11 platform to Facets 4.31, completed ahead of schedule and under budget allowing for an annual savings of $750k.> Redesigned and deployed enhanced commission statements resulting in an improved broker experience and reduction of customer service calls. Project included new A/P upload file allowing for more accurate G/L reporting.> Accountable for managing requests and timely responses to both internal and external audits, including compliance and regulatory requests and complaints; and implementation of quality audits for both commissions and billing working with UHC’s Business Process Quality Management (BPQM) team.> Developed dashboard reporting incorporating capitation, billing, commissions and vendor payments.

Application installations and upgrades:> Responsible for migration of dental DHMO capitation from the legacy MultiClaim platform to Facets 2.96> Managed migration of custom dental DHMO product, Direct Compensation from an acquisition legacy platform to Facets 2.96.> Responsible for migration of dental capitation from the PDBI legacy platform to Facets 2.96.> Planning and testing of capitation for the Facets upgrade to version 4.31.Played a significant role in developing:> Financial controls and policies and procedures related to capitation payments, billing and accounts receivable.> Reporting for internal and external users for ASO claims billing and provider capitation payments.Successfully transitioned PacifiCare capitation payments into the workflow and processes of DBP of California.

Accountable to deliver results, execute with discipline and urgency, emphasis on solutions and opportunities. Responsible for the following duties:Financial Management:> Managed accounts receivable of $20MM, collecting an average of 98.7% of outstanding revenue every month> Designed efficient reconciliation process for comparing paid enrollment to system eligibility to identify underpayments, overpayments which resulted in more accurate system eligibility for improved customer service and assure payment-in-full by the custo006DerProcess Improvement, SOX Controls & Compliance:> Developed a tracking and reporting mechanism for external health plan revenue and eligibility that has become the source of truth for other business groups and is now an integral part of a SOX monitoring control> Successfully implemented initial contract for a non-standard, high profile client which included retooling current processes and developing new ones, and controls to meet contractual requirements and performance guarantees

> Worked with BSC vendor for IT on development, testing and implementation on long-term solution to accurately pay vendors based on eligibility including 12-months rolling retroactivity> Responsible for the review and payment of capitation to vendors providing services to BSC members including mental health, radiology and life services> Reviewed and approved monthly capitation payments including year-end contract settlements for 14 medical groups.

> Established procedures for accounting/bookkeeping utilizing QuickBooks Pro, collections, payroll, human resources, supply requisition and all other administrative services> Maintained relationships with vendors, accountants, bankers and legal counsel> Worked closely with CEO and legal counsel on second round of venture capital funding > Managed facilities, move and remodeling > Organized and coordinated equipment purchases and leases, travel, staff events and board meetings

> Lead a staff of 24 who updated and maintained the eligibility of 500,000 members in California and Arizona > Submitted payroll, tracked and reported daily production statistics and maintained accurate employee records> Directed development of Access database to analyze and load eligibility and monthly activity of membership> Responsible for the deposit of monthly capitation, shared risk and stop loss payments from the health plans> Worked on team that coordinated implementation of acquisition of 250,000 members in California and Arizona