Kelly Wright Email & Phone Number

New York, NY, US

Detroit, MI, US

Hartford, Connecticut, US

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.

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.

Hartford, Connecticut, US

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.

Hartford, Connecticut, US

• Directed Claims Repricing, Customer Service, Enrollment, Business Analysis & Process Improvement, Quality Management/Audit, Training, Reporting & Analytics, Business Implementations, including System Configuration and.
• 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.
• 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%

• 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.
• 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.
• 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.
• Transitioned AS400 in-house, moving from ASP to turnkey client, saving $1,000,000 annually.

• 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.
• 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.
• Participated on administrative, medical, and corporate quality management committees.

Master Of Business Administration - Mba, Finance & Quality Managment

Bachelor Of Science - Bs, Biopsychology