Keaton Sweatt Email & Phone Number

United States

San Francisco, California, Us

- Lead health insurance compliance oversight for Gusto’s benefits products, focusing on digital insurance space and broker practices.- Collaborate with key stakeholders to develop innovative business solutions for product development, design, sales, and administration of health and life insurance products.- Investigate and document processes to ensure compliance with state and federal insurance regulatory requirements such as PPACA, HIPAA, and other relevant regulations.- Review commissions, rebates, and other regulatory requirements related to operations and sales processes.- Serve as a knowledge partner by researching, documenting, and educating others on updates related to internal processes, external policies, and best practices to scale operations and compliance maturity cross-functionally.

Mountain View, California, Us

- Pioneered the enhancement of customer support processes and workflows by introducing automation and integration solutions, resulting in a marked increase in overall efficiency and a reduction in average resolution time.- Maintained a profound understanding of customer behavior and engagement through the adept use of data analysis tools such as Totango and Salesforce. Successfully tracked and measured customer success metrics, contributing to a noticeable improvement in customer retention rates.- Applied advanced problem-solving skills and leveraged experience with Jira to troubleshoot intricate technical issues. Coordinated cross-functional teams to deliver timely and effective solutions to customers.- Functioned as a subject matter expert and mentor for customer support agents, offering guidance on product knowledge, customer service best practices, and technical tools. Played a key role in fostering a supportive and knowledgeable team environment.- Administered various tools and systems, including Zendesk, Salesforce Service Cloud, Totango, Five9, Jira Project, ShareFile, and Make Integromat, ensuring seamless operation and integration across platforms.

Oakland, California, Us

- Elevated to Senior Associate role for spearheading the development of a comprehensive partner program for the Personal Loans vertical, and overhauling data and reporting requirements applied across multiple verticals.

Oakland, California, Us

- Received the company's Exceptional Impact award from the Senior Director for outstanding contributions to process improvement, particularly in streamlining new partner onboarding and implementing automated monthly invoicing. This prestigious award is granted to less than 10% of employees quarterly.- Managed 45+ partner accounts, overseeing personal loans, auto loans, and auto insurance, with a monthly book of business totaling $50M. Led operations and compliance efforts, ensuring seamless onboarding for new partners onto the platform.- Collaborated cross-functionally with partnerships, product, and engineering teams to enhance UI and functionality within internal tools and operational processes.- Served as the primary stakeholder for internal marketing, engineering, and product initiatives impacting partnerships, ensuring strict compliance with partner standards.- Developed and implemented streamlined, scalable partner operations processes covering onboarding and maintenance, pricing, reporting and data quality, marketing initiatives, editorial collateral review, and legal/compliance quarterly audits.- Led communication with partners on operational aspects of the program, including updates on creative content, platform changes, targeting and model updates, reporting requirements, data pipelines, and API maintenance. Oversaw large-scale partner initiatives.- Managed partner-focused projects, acting as the central point of contact for internal and external teams to address and resolve issues promptly.- Oversaw tooling within the team, including building dashboards in Looker, crafting SQL queries in BigQuery, and implementing ticketing systems and project management/tracking tools and software.

Oakland, California, Us

- Spearheaded system administration tasks for Blue Cross Blue Shield of California's credentialing system, ensuring seamless operation and data integrity.- Played a pivotal role in developing and optimizing workflow processes within the credentialing team, enhancing efficiency and accuracy in credentialing procedures. - Led vendor management initiatives, fostering strong relationships with external partners to streamline collaboration and improve overall system performance.- Demonstrated proficiency in analyzing and interpreting complex data to provide valuable insights, contributing to informed decision-making within the credentialing domain.

Nashville, Tennessee, Us

- Spearheaded the development and maintenance of interactive dashboards utilizing Mode, Zendesk, and JIRA, facilitating data-driven decision-making processes.- Leveraged performance metrics and product data analysis to streamline operations, enhancing efficiency and precision.- Orchestrated the design and execution of scalable processes, fostering seamless collaboration between operations and cross-functional teams. This included custom workflows, knowledge management systems, escalation protocols, and ticketing procedures.- Led project management efforts for both tactical and strategic projects, serving as a key liaison between Operations and other departments to ensure successful cross-functional initiatives.- Pioneered the operationalization of provider credentialing processes within the health plan, driving ongoing program success and compliance.- Engineered and maintained automated tracking systems and comprehensive records, optimizing office workflows for heightened productivity.- Conducted thorough research on relevant legislation and laws, applying insights to bolster departmental operations and address potential concerns.- Cultivated and managed relationships with medical staff services vendors and credentialing consultants, ensuring seamless collaboration and effective support.

Minneapolis, Mn, Us

- Collaborated closely with stakeholders to craft and refine reports tailored to support project leads in making informed business decisions effectively.- Diligently tracked and monitored cost plans, ensuring accuracy and timeliness in updating forecasts to align with project objectives.- Conducted in-depth analysis of project finance trends, offering valuable insights and actionable recommendations to project leads for optimized financial management.- Oversaw the seamless flow of project data across multiple software platforms, databases, and record-keeping systems, ensuring data integrity and accessibility for informed decision-making processes.

Minneapolis, Mn, Us

- Led quality review initiatives to uphold compliance with NCQA and Joint Commission regulations, ensuring adherence to industry standards.- Conducted mock surveys and meticulously assessed the completeness and accuracy of provider credentials to prepare the team for Joint Commission audits effectively.- Oversaw the credentialing and re-credentialing processes for a high volume of 80 to 120 providers monthly, maintaining meticulous attention to detail and timeliness.- Developed analysis descriptors to evaluate providers with sensitive backgrounds, determining appropriate alert levels and facilitating necessary escalations for file review.

Pensacola, Fl, Us

- Orchestrated the development, implementation, and oversight of the health system's referring provider sanctions and exclusions monitoring program, ensuring comprehensive compliance with regulatory requirements.- Implemented standardized processes across departments to ensure adherence to Joint Commission regulations concerning patient referrals from sanctioned or excluded providers, fostering a culture of compliance throughout the organization.- Optimized operational workflows by refining procedures for monthly reconciliation of our provider database against OIG, SAM, and state sanctions and exclusions listings, enhancing accuracy and efficiency in monitoring efforts.- Conducted thorough investigations of providers to evaluate their eligibility for true or potential sanction or exclusion matches, compiling detailed reports to facilitate streamlined analysis of findings for informed decision-making processes.

- Managed a department budget exceeding $200,000, achieving an impressive 11.2% increase in profit margins through strategic oversight and resource allocation.- Spearheaded the implementation of apparel ordering algorithms integrated with the company's dashboard, enhancing the reliability and depth of reporting for informed decision-making.- Revamped the yearly inventory process, significantly enhancing efficiency and reducing the personnel required for completion, leading to substantial time and cost savings.- Developed a fair and efficient scheduling system that equitably distributed weekend off-days among all staff members while reducing unnecessary labor hours, optimizing workforce management.

Pensacola, Fl, Us

- Implemented a systematic process for escalating CMS RAC audit medical claims through the appeals process, ensuring adherence to regulatory requirements and facilitating resolution up to the fourth level of appeal.- Compiled comprehensive appeals documents to support CMS appeals packets, ensuring accuracy and completeness in compliance documentation.- Contributed to the enhancement of policies and procedures for reviewing medical codes in appeals, assisting in the development of improved practices to ensure compliance with regulatory standards.- Participated in beta testing and provided valuable user feedback for the development of CMS medical claims audit tracking software, contributing to the creation of a user-friendly and efficient tool for compliance management.

Bachelor Of Science (Bs), Healthcare Administration/Business Management/Community Health

Associate Of Arts (Aa), Business Administration/Pre-Nursing