Responsibilities/Accomplishments: Built and supported positive internal and external relationships. Managed 6-8 IT vendors and monitored performance. Communicated with vendors on day-to-day matters. Researched invoice and contractual issues and resolved discrepancies. Reviewed and negotiated terms of vendor contracts. Negotiated a vendor renewal cost savings of $2M that included any acquisitions being included at no cost for the first year. Influenced department strategies. Resolved complex issues. Prepared vendors for a successful annual enrollment period.

Worked with policy owners, while understanding the end users, to create clear and concise documentation. Wrote policies governing company processes and practices to best serve the end users while ensuring CMS compliance. Exercised considerable latitude in determining objectives and approaches to assignments. Made decisions on complex issues about technical approach for project components. Provided constructive feedback that enhanced the future onboarding process and improvements to the training curriculum of new Senior Policy Administration Professionals.

- Responsible for the performance, compliance, relationship, and management of Medicare Customer Service Partners. - Quarterly KPI/CPI goal setting and communication. - Facilitate and monitor corrective action plans. - Track/trend Concierge escalations (top five call drivers) for insights and opportunities. - Lead Partner performance meetings in collaboration with Experience Transformation Team. - Responsible for providing Quality & Compliance feedback to the Partners. - Partner with Internal Compliance to understand any risk and establish processes to protect business from potential risk. - Voice Call Quality (CMS and AEP Test calls, Short Calls & Call Back) oversight. - Expedited appeals - Partner with G&A team on escalation support. - Lead and guide 200-500 associates indirectly in a call center setting to ensure proper processes are followed. This includes Expedited Appeals, Behavior Health, and the Concierge’s teams. - Implemented the Concierge’s team at Teleperformance Killeen. - Compliance Direct Responsible Individual for Partner Operations. - Reduced Billable Shrink by $1.4M for the Retail Contact Center. - Effectively manage and develop on-site leadership to succeed in meeting metrics while trying to maintain leadership engagement. - Act as a Subject Matter Expert by providing support for on-site leadership and for new hire training classes during on-site visits. - Proactively communicate with on-site leadership to determine barriers to success and implement solutions. - Collaborate with other departments on process improvements. - Partnered with NEPD to develop MSO Claims Discovery training and the MSO Performance Library.

- Implemented the G&A Workflow Redesign. This project reduced the average time of 24-48 hours for CCP inquiries to reach G&A operational queues. The time was decreased to 30 minutes. - Resourceful in working with G&A operations to implement new or revised G&A processes for Mentor. - Build and manage constructive cross-functional teams ensuring that work progresses toward achieving goals and objectives. - Engage operational area and support leadership in initiatives to develop a clear picture of their needs and best practices. - Actively available as a resource for the G&A Operational areas. - Employ expertise, credibility, and effective partnering with Compliance to identify regulatory constraints and ensure that policies are compliant. - Develop compliant communication that is clear and timely in response to the needs of the G&A Operational area. - Appropriately prioritize multiple, long-term project assignments, integrating project research, attending meetings while being responsive to G&A Operational needs. - Attend business meetings with the intent to skillfully recognize impacts to the G&A Operational areas.

- Reduced CRU’s Aged Inventory by 14% in 30 days. - Reduced Man Calc’s Aged Inventory 87% to 7% in 30 days. Reducing days on hand by 7 days. - Implemented the assignment of work and the Aged Inventory Report in order to hold associates accountable. - Reduced Correspondence’s Inventory by 15% in 54 days. Reducing days on had by 4.3 days. - Handle escalated issues from all internal and external customers. - Monitor inventory and develop plans to reduce it. - Generate and monitor reports and unit metrics - Conduct and track associate Side by Sides and provide coaching. - Build policy and procedures to improve quality and accountability. - Six Sigma Green Belt trained. - Develop and maintain training for current and new associates. - Special projects as assign by management.

- Monitoring metrics within the Medicare team, as well as, vendor ID Card to identify levels of quality, maintaining and reviewing personnel records. - Work collaboratively with Medicare Service Operations leaders in Enrollment, Customer Service and Information Technology to improve processes. - Monitoring Vendor performance including address work flow, process design, capacity, and service issues. - Reviewing of all Medicare letters, automatically or manually generated for content consistency, compliancy and accuracy. - Create policy and procedures to improve quality and accountability. - Developed reports in order to generate and monitor reports and unit metrics.

- Responsible for coordinating training and workflow for ten - twenty Analysts and Screeners. - Responsible for the daily management of the IPD inventory. - Ensure completion of all “screener” duties for time sensitive issues. - Monitor department and individual case load inventories and on a daily basis to ensure each case is worked in timely manner. - Review and evaluate cases to determine compliance of state legislative issues. - Review and coach associates regarding proper claim payment procedures, member or provider inquiries and department expectations for case inventory and management by utilizing the Pend. - Monitor Acknowledgement and ICS aging reports on a daily basis. - Responsible for the team and individual improvement of case file quality, productivity and claim knowledge through daily side by sides, one on ones and case evaluations. - Responsible for researching, reporting and presenting all assigned projects in a timely manner.

- Responsible for coordinating training and workflow for ten - twenty Customer Service Representatives servicing the Provider call department. - Monitor department service levels throughout the day to ensure proper phone coverage and that service level commitments are met daily through close communication with the work force management traffic desk. - Attend and participate in all cross departmental meetings to ensure strong relationships and better communication with Provider Relations, Market Offices and Provider Connectivity. - Responsible for the coordination and execution of the Provider call transition. This includes coordinating all training material and training staff, scheduling classes, monitoring material effectiveness and communicating to the call center leaders on a weekly basis. - Responsible for Human Resource duties including, but not limited to, interviewing, hiring, training, performance reviews, disciplinary action and attrition.

- Served as the interim Medicare contact person for Humana’s LSC during the Manager vacancy. Served as the interim Medicare contact person for Humana’s LSC during the search for a permanent manager. - Review the “Active Outlook” magazine for Medicare on behalf of Humana. - Directly responsible for supervising the workflow for seventeen non-exempt associates; including CSCS, Help Desk (both Commercial and Medicare), team leads and management trainees. - Utilize extensive knowledge of ACD phone system and monitor Symposium reports as well as multiple systems such as GH/CI, CAS, BADGER, and ICS/EA in order to respond accurately to internal and external inquiries. - Provide and organize Medicare ANOC training throughout LSC.

- Assisted internal and external customers with problems resolving calls whether it is benefits questions or claims processing issues. - Provided ongoing support and assistance to our customer service claims specialists. - Assisted education and development with training. - Performed CSCS activities with greater technical depth, which included claims processing and reading/reviewing contracts of both employer groups and providers. - Utilize extensive knowledge of ACD phone system and monitor Symposium reports as well as multiple systems such as GH/CI, CAS, BADGER, and ICS/EA in order to respond accurately to internal and external inquiries. - Provide and organize Medicare ANOC training throughout LSC.