ClaimsManages a team of up to 36 Associates that are located in three locations (California and Connecticut) working on multiple systemsCoordinates Claims budget of $35 millionWorks with the Team on various Claims reports, scheduled and adhoc, for multiple departments (i.e. Legal, Compliance, Claims, Medical Mgmt, Audit, etc. )Has a team of Claims Testing members that validate system changes prior to implementing into productionRetained Team members under the Manager position for Paper Claim, Electronic Data Interchange, and Claims projects

ClaimsManages a team of eleven AssociatesWorks through issues relating to the lifecycle of various Claim projects. The Claim projects are Compliance, System Enhancements, Process Improvement, or New Regulations driven. Owns the relationship with the Paper Claim and Electronic Data Interchange vendors.Continued to represent Claims in several cross-functional projects (i.e. HNOne system conversion and Accumulator project

ClaimsCoordinates multiple Claim projects from beginning to end by ensuring project objectives are accomplishedResponsible for communication of project information to all affected departmentsRepresents Claims in several cross-functional projects (i.e. Health Network Systems, Valutech, and Unity system implementations

Prepares Monthly, Quarterly, and Annual statistical reports for Senior Management (Global Audit Status report, Vacancy report, Departmental Return On Investment, and Ad Hoc reports)Supervises and trains three Audit Analyst every six months to prepare audit files from low to high complexity for the auditorsPre-assess risks associated with compliance audits to be preformedPerforms extensive research from internal and external sources to assist the auditors in completing compliance audits

Ancillary Provider ServicesCreated Policies and Procedures for newly created Ancillary Services Department (which included creating contract templates for departmental use)Managed and updated Health Net's standardized fee schedules for ancillary specialtiesNegotiated and created provider contractsAssisted providers with problem solving of health plan operational related issues (i.e. capitation, claims, and eligibility)