•Effectively leads team of auditors responsible for operational audits within the business in areas of claims, customer service, appeals, financial cash control, and drug rebate to ensure adherence to SLAs set forth by client.•Works with internal customers to develop mitigation plans and remediation in the event areas of non-compliance are identified during routine audits.•Works successfully with independent quality management contractor during independent audits.•Provides transparent client communications around contractor operations and performance.•Monitors spending for adherence to budget and recommends variances as necessary.•Works as a point of contact for the improving of business operations and initiatives.•Oversees the single audit point of contact for both the client’s audits as well as Gainwell audits.

· Develop a company-wide talent development strategy and vision.· Engage with stakeholders to assess training gaps, organizational development needs for training and staff development to enhance the effectiveness of employee performance in achieving the goals and objectives of the company.· Develop and maintain training elements (i.e. various training development roadmaps, communication plans, facilitator guides, training documentation, training assessments, etc.).· Provide oversight and strategic vision around training modalities, learning technologies and LMS solutions.· Manage LMS system (Relias) to ensure relevant course offering, tracking enrollment and course completion.· Create engaging training and development solutions to be delivered in a live face-to-face environment as well as delivered via eLearning tools.· Responsible for overall onboarding training, technology training, leadership development training, and non-clinical skill set development.· Conduct post session training evaluations.· Manage training staff including talent selection, staff development and ongoing coaching.

• Provide subject matter expertise, business leadership skills and controls around multiple processes both internally and externally to mitigate regulatory risk, assist with robust quality programs and ensure CMS and state compliance• Cultivate partnerships and engagement with internal and external vendor partners using expert professional knowledge and acumen to advise matrix and functional leaders as well as exercise considerable creativity, foresight and judgment in conceiving, planning and delivering on initiatives• Lead audit team tasked with conducting reviews of various areas within Sales as well as contracted FDRs to identify and remediate gaps in policies and procedures• Analyze the effectiveness of existing business processes and developing sustainable, repeatable and quantifiable business process improvements• Partner with various units within Sales on complex operational audits and regulatory inquiries by providing technical, procedural and regulatory expertise• Oversee Sales Quality Monitoring process, including developing evaluation tools and creating reports distributed to Sales Executive Leadership team• Provide agent performance management opportunities to Sales managers in order to ensure compliance to CMS Sales and Marketing regulations• Manage staff of 10 auditors who monitor 6800 Medicare Advantage Sales agents across 15 states• Lead multi-year project focused on improving CMS Star Ratings across the organization, resulting in all MAPD contracts scoring below or at compliance threshold (75%) before involvement to 100% of contracts scoring 4 or 5 stars 95%+) on Foreign Language/TTY audit over consecutive years

• Oversee Sales Quality Monitoring process, including developing evaluation tools and creating reports distributed to Sales Executive Leadership team• Provide agent performance management opportunities to Sales managers in order to ensure compliance to CMS Sales and Marketing regulations• Handle remediation and assisted in post-audit validation of corrective action plans for internal and external Medicare Advantage sales call centers• Manage staff of 10 auditors who monitor 6800 Medicare Advantage Sales agents across 15 states• Lead multi-year project focused on improving CMS Star Ratings across the organization, resulting in all MAPD contracts scoring below or at compliance threshold (75%) before involvement to 100% of contracts scoring 4 or 5 stars 95%+) on Foreign Language/TTY audit over consecutive years• Ensure compliance to CMS rules and regulations across call centers across Sales organization• Develop and update applicable policies and standard operating procedures for Sales Call Center Oversight• Serve as Verint business unit administrator for three departments and develop processes which were deemed best practices by IT department, which has led to becoming SME for other business unit admininstrators within the organization

• Developed dynamic instructional material using Captivate and Articulate. Coordinated, wrote and edited educational content for over 25 modules regarding subject matters such as Medicare Compliance, Medicare 5 Star Plan Rating, and Health Services. Uploaded and deployed these training modules using SCORM.• Resolved issues within the Learning Management System regarding user creation and maintenance, enrollment, password resets, etc. for over 3,500 employees. Created a process streamlining amount of contacts required improving resolution time by 50%.• Identified, coordinated with HR and IT departments, and led effort to resolve Outlook and Learning Management System user name duplications during Health Spring and Cigna merger. This reduced current and ongoing training-related compliance risks for all new hires.• Identified classroom training enrollment issues and took responsibility for entering over 1,000 instructor-led courses into the Learning Management System. Enhanced the communication process, which improved enrollee preparation in addition to significantly reducing instructor workload.• Created InfoPath and SharePoint forms improving input process utilized by trainers and managers to provide accurate information for class input into Learning Management System.• Responsible for creating weekly management reports as well as on-demand reports for employees, leaders and senior leadership regarding enrollment and completion of online modules.• Received 6 employee awards from Managers and Trainers in recognition of teamwork and service to internal customers.

Conducted needs assessment of all customer service departments within the company and prepared and delivered effective training based on departmental needsExpanded knowledge of Managed Care to include Medicare Part C benefits and policiesDelivered onboarding training to both pharmacy and Part C Customer Service representatives.Created uniform training manual for Pharmacy, Part C, and Provider Customer Service departments.Created online training modules using Brainshark and Articulate Online to address ongoing departmental training needs.

Trained large and small classes of newly hired full-time and temporary employees on all pharmacy department operations and procedures.Trained department staff on policy, procedure, and compliance changes.Effectively coached employees on procedures to ensure performance improvement.Worked with PBM to ensure their customer service call centers were trained properly and remained in compliance with CMS standards.Acted as telephone resource for Pharmacy Call Center, taking questions from employees and escalated calls from members and providers.Provided ongoing training for management and department on as needed basis.Increased audit scores of Pharmacy Customer Service from 75% to 90% by delivering ongoing training based on needs of department.

Effectively handled daily high volume of calls from members, pharmacies, and doctors' officesResolved issues with members and pharmacies regarding claims adjudication, premium payments, and formularyTrained new hires in one-on-one and classroom settings by instruction and observationServed as resource for pharmacy department to assist with resolving member and provider issuesConcisely documented phone calls from members and providersAssisted in other duties as needed, such as aiding enrollment in ordering ID cards for members and closing prior authorizations during high volumesKnowledgeable of department policies and proceduresStrived to aid department in achieving CMS phone compliance during challenging time of yearActed as team player, being flexible and open to department and company needs

The nation's largest drugstore chain with 7,830 drugstores in all 50 states, the District of Columbia and PuertoRico.; � Entered, filled, and sold prescriptions to customers as well as assisted customers with insurance and over-the-counter medication questions. � Managed inventory for department, including performing counts on medications and returning overstocked and expired medications back to vendors and warehouse. � Communicated with Spanish-speaking customers and served as a translator between customers and pharmacists. � Trained newly hired technicians and pharmacists on point-of-sale and computer issues.