I have developed and executed operational & technology strategies to support revenue growth, client retention, compliance, and network integration strategies for ASA, Cofinity, & First Health. I was first tasked with integrating the Aetna Network Access Business Operations team with the First Health Operations Team. I assessed leadership and operational processes from each team and implemented best in class processes. I was able to achieve acquisition synergies of over $4M, delivering above target; 2 years ahead of plan. Then my focus became a seamless customer experience since there were shared clients between the different businesses, yet different processes and systems required to access the same team. These disjointed processes caused confusion and frustration. So, we set off to implement this vision of service excellence. It was during this time that I was selected as the Achieving Business eXcellence (ABX) Business Unit Lead for ASA, Cofinity, First Health, Meritain, and American Health Holdings (AHH). In this role, I ensured that all employees became white belt certified and all leaders also became yellow belt certified in Lean & Six Sigma methodologies. Additionally, I worked with the senior leaders to develop a continuous improvement (CI) roadmap with a focus on the Voice of the Customer. It was through ABX that I coordinated 4 Value Stream Design events and 1 Kaizen project and assisted in the mentoring of the project managers. I also coordinated the efforts to achieve CI cost savings of over $2.8M in the first year and outlined the plan to identify opportunities for the collective businesses to achieve over $12M in subsequent years. Lastly, my team & I implemented digital accessibility standards (WCAG 2.0) for the ASA, First Health and Cofinity websites in April 2017, to meet the requirements of the Affordable Care Act 1557 standards. We also implemented over 300 legislative requirements into the site and business processes by end of 2017.

I was accountable for growth and retention of a P&L of over $50 million in revenue for the Cofinity suite of products including; medical network access, Institutes of Excellence, a transplant product, dental, automobile network access, and workers’ compensation. To stay relevant in this dynamic market, it was necessary to diversify the product offering by developing new products, leverage existing Aetna capabilities, and execute relationships with strategic partners to supplement our product offerings. The first initiative was the development and rollout of a network discount improvement initiative. I worked with network, legal, & operations to develop the program requirements & processes. I also participated in facility discount negotiations, the marketing campaign & the generation of new business. We added over 10,000 new members within the first 6 months of the rollout, and the sales pipeline doubled compared to the previous year. Next, I directed the national expansion of the automobile network access product, including the regulatory review of auto regulations in targeted states, development of new provider contract boilerplates and the respective competitive market target rates, and led the negotiation with key strategic network partners adding over $1M in increased revenue. Then we enhanced the transplant network access product by leading the expansion of the national network from 70 to over 100 facilities. Additionally, we developed web technology to support contract transparency and streamline the user experience, developed the product value proposition, and rolled out new product pricing. Lastly, I re-instituted client forums; including agent advisory councils, partner forums, and re-insurer initiatives to solicit client feedback, demonstrate appreciation, maintain retention, and generate new business opportunities.

In this role, I led Claims Repricing, Customer Service, Enrollment, Business Analysis & Process Improvement, Quality Management/Audit, Training, Reporting & Analytics, Accounting, Business Implementations, including System Configuration and End User Testing, and Information Systems (IS), including Electronic Data Interchange (EDI), Application Development, and Technical Support/Architecture in multiple regions across multiple product lines. I truly enjoyed the opportunity to direct the operational turnaround for the Aetna's Workers' Compensation Division. The first area of focus was on the resolution of multiple compliance issues. We identified and prioritized all issues, outlined solutions and worked with IT for implementation. Additionally, I was able to reduce the headcount by over 75, by streamlining processes, implementing automated solutions and outsourcing key businesses processes. I also played a key role in working with our key clients to fix issues and improve their service experience with our organization. During this time, I also partnered with our finance team to review vendor contracts, business processes, personnel, marketing materials, and other expense drivers, ultimately reducing over $10M of the SG&A expense over 3 years. Lastly, we implemented the 5010 EDI standards within our own team as well as with our clients and business partners.

Directed Claims Repricing, Customer Service, Enrollment, Business Analysis & Process Improvement, Quality Management/Audit, Training, Reporting & Analytics, Business Implementations, including System Configuration and End User Testing, and Information Systems (IS), including Electronic Data Interchange (EDI), Application Development, and Technical Support/Architecture in multiple regions across multiple product lines. • Fluent in operational business processes and best in class operational benchmarks for commercial group health PPO, workers’ compensation and auto/vehicle product lines. • Led two system conversion initiatives from proprietary systems to a new repricing claims system. Workers' compensation and auto products in 2005, and an acquired PPO company in 2007. Managed the project, multiple vendor relationships, and over 10,000 hours in IT development. • Ensured claims turnaround time of over 99.3% in two days and 100% in four days for group health and over 99.8% in two days and 100% in four days for workers’ compensation and auto.• Decreased the call center average speed of answer from 30 seconds to fewer than 3 seconds and reduced the abandonment rate from 4% to less than 1%, without increasing staff. • Increased EDI files inbound from our clients to over 88% and EDI outbound files to the clients to over 95%• Achieved/maintained auto repricing (i.e. no human intervention) rates of 90%. • Implemented compliance projects, including NPI, HIPAA, and Present on Admission Indicator (POA).• Speaker at the International Association of Outsourcing Professionals (IAOP) conference on managing multi-vendor relationships and the business strategy.

Directed Claims Repricing, Customer Service, Enrollment, Business Analysis & Process Improvement, Quality Management/Audit, and Training. Responsible for the development of efficient and cost-effective business solutions for daily operations and strategic initiatives.• Served as project manager to install a vendor claims repricing platform for the group health product line. Conversion entailed over 40,000 hours of development from a system vendor as well as conversion of over 14,000,000 claims, 1,300,000 members and their enrollment history, and 50,000 providers and their respective fee schedules and contracts. Trained staff on the system and worked closely with over 250 payer partners to ensure a seamless transition for outbound EDI claims. • Automated business processes and served as an expert on hospital/facility contracts which increased auto repricing (i.e. no human intervention) from 40% to 90%• Reduced headcount in our claims processing department from 100 to 34 through system automation and business process outsourcing.• Assisted in the implementation of outsourcing arrangements with multiple vendors and the applicable business rules for mail handling, including the processes for open, prep, sort, scan/image, and claims keying, working claims queues and outbound claims printing, saving millions of dollars. • Transitioned AS400 in-house, moving from ASP to turnkey client, saving $1,000,000 annually. • Assisted in the detailed project activities of the URAC Accreditation Initiative, ultimately obtaining accreditation after the onsite reviews. • Introduced quality audits on key operational processes and assisted in the implementation of the Key Performance Indicator (KPI) reports.

Led a team of Business Analysts and Quality Managers that focused on Continuous Improvement initiatives, managing the implementation of strategic initiatives, and auditing of key business processes.• Guided request for proposal (RFP) process to search, review, and select claims system to replace legacy computer repricing platform. Participated in vendor demonstrations and the ultimate selection of the computer system outsourcing arrangement. • Contributed to the analysis/business design of a data entry mechanism, to enter and transform paper claims into electronic data (EDI) records.• Researched and developed business requirements to automate the repricing of UB92/UB04 hospital/facility claims via EDI, using knowledge of diagnostic related groupers (DRGs), revenue codes, and contractual pricing, including inlier and outlier arrangements. • Participated on administrative, medical, and corporate quality management committees.