Hillary Caffey Email & Phone Number

Fort Worth, Texas, United States

Fort Worth, Texas

Irving, Tx

In January 2015 I transitioned to CSC from my management position at HealthMarkets. I continue to support operations for claims processing for clients. In addition I oversee operational trainers, auditors and a business analyst. My role includes support to the operations business units including gathering and writing business requirements, supply support for training needs and consult in opportunities for improvement.

I am accountable for managing Supplemental claims processing, I am a Liaison to external partners for management of Supplemental operational processes and reporting. I support all customer experience of the Supplemental products across operations including consulting on Support Services for Members and Producers and New Business/Underwriting. My responsibilities also include creating and documenting policies and procedures for Supplemental Operations.

Accountable for managing backend operations for Supplemental insurance. Responsibilities include managing the Support Services for Members and Producers and the processing of claims for up to 18 Supplemental products in approximately 35 states. I also consult in front end processes such as New Business/Underwriting. Responsibilities also include creating and documenting policies and procedures for Supplemental Operations

Accountable for managing projects that impact Operations. Responsibilities include creating and maintaining business decisions by the Executives, writing business rules based on business decisions, assist in creating policies and procedures within Operations, coordinating implementation efforts with IT and releasing communication to Operations and other impacted parties. Current Projects include Health Care Reform (PPACA) and Supplemental Operations.

Responsible for identifying process improvements for the company. Participated in identifying current processes and areas of improvement. Participated in gathering business requirements from all business units, writing business requirements, coordinating efforts with business units and IT, and assisting in the implementation of the projects. Primary project August 2009 to January 2010 was implementing a third party administration of the companies supplemental products.

Responsible for support of the claims systems and processes to include assisting customer service representatives and examiners with system issues. Participated in defining and writing requirements for system and process implementations. Tested new systems and processes and ensured timely implementations. Wrote business documentation to support implementations and policies and procedures.

Responsible for the supervision of approximately 12 Customer Service representatives, oversite of a call center supporting calls related to claims and benefits for health insurance coverage. Managed call volumes and staffing and produced daily and monthly reporting on the call stats. Participated in requirements for projects to enhance systems and processes for the Claims Customer Service group. Participated in the testing, implementation and writing of the policies and procedures for new systems to include a new "smart screen" used for single access of materials and data necessary for the Customer Service department to answer calls.

Responsibilities included taking inbound calls from Customers and Agents regarding claims status and policy benefits for individual health plans, assisting other Claims Customer Service Representatives, training new representatives, adjudicating claims due to esculated calls, and auditing other representatives. Also participated in projects for system enhancements for Claims Customer Service to include IVR, Image, and other system enhancements.

Responsibilities included taking inbound calls from customers and agents regarding claims status and plan benefits for individual health plans.