James Higgins Email & Phone Number

Milwaukee, Wi

Analyzed and interpreted hospital and physician contracts across PPO Networks within a given state and marketEvaluated new network opportunities within a market to enhance savingsAnalyzed pharmacy claims data and developed quarterly reports to track trends and member costsAutomated monthly and quarterly pharmacy claims reconciliation processes to ensure accuracy in reported numbersAudited quarterly refunds received for pharmacy claims and recovered thousands of dollars owed to our company Presented pharmacy claims data training to provider management department and new employeesCommunicated proposals with recommendations on PPO factors to product linesCreated macros to make data input of hospital and physician contracts more efficientUpdated and maintained network pricing modelsTrained new team members and interns on pricing models and processes

2007, 2008Enhanced databases to improve processing speed and accuracy of routine macrosImplemented a new process for determining rates utilizing Excel and AccessReviewed reports and data tables for accuracy

Responsible for daily cash managementWorked in a team environment to provide excellent customer serviceImproved customer shopping experienceProblem solving to address customer issues and complaints

Actuarial Science, Actuarial Science

Activities and Societies: Actuarial Science Club, Intrameral basketball and dodgeball

Bachelor Of Business Administration, Actuarial Science