Recruited to start-up claim processing operations. Hired staff of 15+, oversaw and directed configuration of Facets, developed standard operating procedures, and established desk level procedures and policies. Managed behavioral claims for 2M covered lives. Served as primary claims SME during implementation of 1st large BCBS risk account, ensuring customer business rules and guidelines were configured and applied accurately and training staff to handle new claims. Re-negotiated outsourced claim processing contract terms, achieving $450K saving. Championed in-sourcing of claim processing, reducing costs and enhancing claims quality. Partnered with sales and marketing, responding to RFP's and creating sales presentations to outline claim capabilities using performance data, metrics, and process overviews. Drove claim system configuration changes and IT programming, increasing auto-adjudication rates to 92%.

Provided leadership and oversight for team of 150+ associates handling day-to-day activities associated with claim operations for more than 12M covered lives. Focused on achievement of timeliness goals and accuracy results required by customer and state and / or federal regulations. Developed and managed multi-million-dollar annual budgets in support of corporate financial targets. Participated alongside sales and marketing in responding to RFP's as well as attending sales finalist presentations and meetings. Served as Business Owner of claim systems and partnered with IT, identifying opportunities for improvements, creating enhancements, and improving efficiencies. Recruited and developed high performing team as well as established and implemented department guidelines, creating positive work environment and retaining staff as demonstrated by attrition rate of <6% during tenure. Implemented new customers and program expansions to complete satisfaction of customers, providing timeliness and accuracy measures to meet or exceed expectations post go-live. Collaborated across departments, devising and refining processes which drove improved claim processing outcomes. Participated in developing capabilities to support company's full health plan product, Magellan Complete Care of Florida, including responsibility for claim processing unit.

Solely responsible for on-time new customer implementations. Ensued client design was supported by system configuration. Hired, trained, and supported staff to begin processing at go-live. Worked with Perot Systems consultants to install Amysis claims system and subsequent conversions of legacy systems

Supported expansion and centralization of claim department as result of mergers and acquisitions. Hired staff to support processing on multiple claim systems and varied lines of business.