Assisted in the development of business strategy for the healthcare consumer experience and provided analytical support for various initiatives• Collected and analyzed performance data in order to identify new opportunities.• Served as a leader/mentor and subject matter expert for a newly adopted road mapping tool for strategic planning and leadership reporting.• Analyzed and researched technology and operational issues independently.• Collaborated with senior management and analytics and reporting teams to develop an end-to-end view of the healthcare provider experience.• Assisted senior management in developing and executing call center strategy.• Partnered with internal and external business partners to foster improvements in new healthcare provider self-service tools.

Defined project scope, objectives and documents business processes and solutions for Reimbursement, Medical and Drug policies• Consulted with multiple business departments to identify requirements needed to implement new projects and evaluated system changes for downstream system and/or organizational impacts.• Validated all functions perform according to the relevant specifications.• Maintained a working knowledge of databases, file systems and architecture that support the application.• Developed and preserved working relationships at all levels of the business unit.• Facilitated group meetings via WebEx and telephone, providing agendas and follow-up with meeting minutes.• Managed small and large projects from inception through implementation, prioritizing and tracking issues.

Conducted audits, performed extensive review and analysis and identified trends utilizing Six Sigma methodology on an ongoing monthly, quarterly and annual basis to determine root cause• Created and maintained a reporting portfolio including remediation plans, business processes and slide decks to correct and eliminate claim overpayment scenarios and improve call audit scores.• Scheduled and facilitated brainstorming sessions for root cause and solutions discussions, bringing together processors, agents, supervisors and managers who were directly involved.• Developed and implemented project framework and presentations to be used in advancing the initiative.• Assisted as a Claims subject matter resource to team members, supervisors and management staff.• Provided deep-dive analysis on an ongoing basis in order to prepare for potential upcoming external audits.• Demonstrated root cause identification and analysis to report, track and correct error trends.

Performed internal audits that included high dollar claims ranging from millions of dollars, and multiple focus audits• Team lead of escalated reviews of outstanding issues needing immediate resolution.• Communicated quality decisions between auditors, SMEs, supervisors, managers within the department as well as faced out to the Business Partners involved.• Handled workload balancing for the team, ensuring team and department production goals were met on a daily, weekly and monthly basis.• Provided individualized and group training of employees on the methods and policies of claims handling.• Member of the Process Improvement Team within the Quality department to assist auditors with new processing. topics and prepared refresher presentations to help remediate known auditor issues.• Helped to create, implement and initially train the Continuing Education program for all auditors.

Adjusted claims due to processor error, internal system issues or additional information being received based upon documented methods and reimbursement policies• Performed in-depth research for each claim to provide the most accurate adjustment possible utilizing over eight different knowledge databases. • Worked directly with Account Managers to identify trends within performance guarantee groups as well as determining root cause for processing errors. • Managed internal projects that required special care to resolve account issues. • Corresponded with providers and customers to alleviate escalated issues.

Processed and completed medical claims at an average of 6,000 claims per month based upon documented methods and reimbursement policies. • Worked within a team to meet weekly and monthly deadlines, as well as provide tips and feedback to fellow associates on policy specific guidelines.• Corresponded with vendors, providers, advocates and customers to obtain additional information in order to process claims.

• Seasonal data entry work during tax season • Data transcription of 1040-A tax documents at over 10,000 keystrokes an hour into the IRS computer system• Worked within a team of 20-30 to meet nightly and weekly deadlines.

• Reviewed and processed claims for alternative reimbursement accounts• Acted as primary account manager for Fidelity Investments, a 25,000 employee company• Secondarily assisted 10 other key accounts • Managed customer inquiries both from the executive level and from employees• Provided weekly and monthly updates of account activity for employee benefits disbursement.