● Managed multiply operations teams for the PDP plan, these include: Claims processing, PDE, Reprocessing/Adjustments, Grievances,Paper Claims, and Quality Assurance● Provided the technical and leadership skills to ensure successful Part D claims operations and program compliance for each area ofresponsibility.● Made business decisions that impacted members, providers, the PDP plan and the company. Requiring knowledge of Medicare Part Dplan rules and CMS (Centers for Medicare and Medicaid Services) guidance.● Managed claims processing, monitoring, and oversight. Working with internal partners to ensure established rules, policies and procedureswere implemented and followed. To ensure successful, efficient, auditable Med D operations in compliance with CMS requirements.● Developed strategic, operational and tactical business plans to achieve desired business goals for areas of responsibility.● Reviewed and directed service operation performance to meet or exceed business goals.● Provided leadership to the team for claims oversight including processing and review of rejected claims, approved claims, paper claims,appeals, PDE, reprocessing/adjustments, Grievances and Quality Assurance.● Built and maintained collaborative relationships and alliances with internal partners and external customers to achieve business goals.● Fostered confidence and trust with direct reports, client base, and other cross-functional partners..● Identified gaps and implemented process improvements on multiple systems and procedures within the business unit.● Recruited, developed, motivated and managed a high caliber of talent. Maintained a positive work environment that supported self-directedteams; providing a structure to optimize the experience, skill, knowledge and capability of the teams I managed.● Developed and managed department budget. Including determining and justifying headcount, salaries, etc

Break down of each position, in over 21 years of service, listed below.

- Review regulatory guidance from federal and state entities. Determine compliance impact to ESI and our clients.- Manage HCR Cost-Sharing Reduction Subsidy implementations.- Manage the development of new products in support of Healthcare Reform new guidance. - Manage all Healthcare Reform product implementations for existing clients. - Provide consultative services to implementation team for new clients, account teams and existing clients regarding HCR products.

- Managed all new Health Plan Medicare client Implementation benefit configurations- Managed a team of 6-9 Medicare Benefit Coordinators and Consultants, who work on EGWP/MAPD/PDP migrations, renewals, and new installs- As part of my responsibilities in this role ensure account structure, benefit configuration, member communications, and testing was all completed accurately and timely- Worked with many cross functional teams and the client to gather requirements and ensure proper set up