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Experienced Health Plan Operations leader that strives to use facts, data and insight to work with people, process and technology to achieve efficient and effective Health Plan operations. My experience includes leading operational teams, process improvement initiatives, system implementations, upgrades, configuration, and operational integration of acquisitions.
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Sr. Manager, Healthcare SolutionsHighpoint Solutions May 2013 - PresentEast Norriton, Pa, Us -
Project DirectorBlue Cross Nc 2016 - 2016Durham, Nc, Us -
Configuration Lead System Implementation- Healthrules Payer, Optum Ces, And Optum EasygroupElderplan Inc 2014 - 2016Led configuration team for two phase implementation of core claim system resulting in 15% increase in auto adjudication. The system implementation included integration with clinical editing and grouper/pricer software, data conversions (provider, claims, authorizations and members) and integration with HealthRules Care Manager in phase two. Responsible for resource planning, SOW development, Configuration Plan, monitoring and reporting plan progress, issue tracking, resolution and escalation if needed, and knowledge transfer to client resources. -
Health Plan Operations Sme - Claim Platform Procurement ProjectElderplan Inc May 2013 - 2013Developed operational segment of Request for Proposal, Proposal Checklist, Finalist Demonstration Scenarios, Selection Criteria and Scoring, and served as System Selection Panel Member representing Operations.
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Director Product AdministrationPriority Health 2007 - 2012Grand Rapids, Mi, UsResponsible for implementation of new products (organization entered Individual Market, Dental, Vision, MediGap, and Medicaid Dual Eligible), regulatory requirements (Federal Health Care Reform and State of Michigan), new benefit plan designs, key accounts and all self funded accounts (successfully implemented 11 key accounts in 2011). Managed annual benefit plan updates for all product lines (rating, filing, configuration, document revisions and training). Responsible for FACETS table maintenance. Served as Operations Representative for Key Account sales and service. Led organizations ICD-10 Impact Analysis and development of ICD-10 Project Plan. Appeal Committee member and back up Facilitator. -
Director Enrollment And Fulfillment ServicesPriority Health 2006 - 2007Grand Rapids, Mi, UsResponsible for member enrollment, group set up and benefit plan configuration, and distribution of post enrollment member materials for all product lines (Group - fully and self insured, Government Programs - Medicare and Medicaid, and Individual. Served as lead for Enrollment, Group and Product functions through FACETS upgrade and Health Plan Acquisitions. Plan size increased by 25%. Enrollment team productivity doubled. Improved timeliness for new and renewing group implementation (from 40% to 80% complete prior to effective date). Managed vendor relationship for ID Cards and Member Materials. Improved timeliness for distribution of member materials (from 120 days to 30 days following enrollment).
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Director ClaimsPriority Health 2002 - 2006Grand Rapids, Mi, Us
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Sr Manager Aso OperationsPriority Health 2000 - 2002Grand Rapids, Mi, Us
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Manager Aso OperationsPriority Health 1998 - 2000Grand Rapids, Mi, Us
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Quality Improvement CoordinatorBlue Cross Blue Shield Of Michigan 1997 - 1998Detroit, Michigan, Us -
Business System Analyst ClaimsBlue Cross Blue Shield Of Michigan 1996 - 1997Detroit, Michigan, Us
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Senior Field AuditorTravelers 1989 - 1995New York, Ny, Us -
Individual ContributorTravelers 1989 - 1995New York, Ny, Us
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Benefit SpecialistTravelers 1989 - 1995New York, Ny, Us
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Quality LeaderTravelers 1989 - 1995New York, Ny, Us
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Trainer And Sr Benefit SpecialistTravelers 1989 - 1995New York, Ny, Us
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Technical AdvisorTravelers 1989 - 1995New York, Ny, Us
Joni Wagner Skills
Joni Wagner Education Details
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Michigan State UniversityBusiness Administration
Frequently Asked Questions about Joni Wagner
What company does Joni Wagner work for?
Joni Wagner works for Highpoint Solutions
What is Joni Wagner's role at the current company?
Joni Wagner's current role is Health Plan Operations Professional.
What is Joni Wagner's email address?
Joni Wagner's email address is jo****@****lth.com
What is Joni Wagner's direct phone number?
Joni Wagner's direct phone number is +161694*****
What schools did Joni Wagner attend?
Joni Wagner attended Michigan State University.
What skills is Joni Wagner known for?
Joni Wagner has skills like Leadership, Business Process, Process Improvement, Health Insurance, Six Sigma, Insurance, Business Analysis, Project Management, Business Process Improvement, Strategic Planning, Cross Functional Team Leadership, Employee Benefits.
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