Lori Dodge Email & Phone Number

Appleton, Wisconsin, United States

Manager of ConfigurationGuide team to implement configuration updates to the QNXT operating system related to contract and benefit changes. Add new and renew employer groups in system according to current sales agreements. Engage employees and empower them to drive results through strategic planning and collaboration. Participate in product development activities to drive company values and promote new business opportunities.• Collaborate with team and department leaders to move Medicare claims processing segment from an outside vendor to in-house processing segment. • Quality focus on configuration processes. Partner with Quality Audit department to build program that identifies improvement opportunities to promote accurate benefit and contract system build.• Drive continuous improvement and organizational change within company based upon Lean Six Sigma principles.

Green Bay, Wisconsin Area

Provider Payment Integrity / Prepay Audit Claims Operations Manager 2012 – 2017Engaged associates to maximize contribution and drive operational execution of business strategy. Promoted communication and collaboration to identify and implement process efficiencies, and perform system enhancements. Vendor Management Leader.• Led production teams, including vendors, through managing prepay inventory and identifying efficiencies, exceeding prepay claims processing goals by $54.2M.• Collaborated with team to automate and improve processes, reducing department’s administrative costs by $993K.• Implemented and maintained claims processing quality audit program, achieving 99% company financial payment expectation through quality focus auditing.

Green Bay, Wisconsin Area

Supervised several teams to improve post-pay claims processing and review for company. Led Financial recovery Research, Customer Service, and Post-pay audit teams.• Project lead on continuous improvement process team to create and implement department production tool which moved inventory from databases to web based applications, allowing work to be completed more efficiently and increasing overall production.• Collaborated with dental partners, creating prepay claims audit process and monthly savings for the company.• Devised cross-training classes for associates to learn new products and platforms, expanding development and growth opportunities.

Green Bay, Wisconsin Area

Correspondence Team Leader 2005 – 2007Assisted in development of team members to complete processing of provider correspondence inquiries from a post-payment perspective. • Partnered with supervisor in daily production activities, achieving team quality and performance goals. • Performed monthly audits and provided feedback, ensuring associate’s quality of work standards were met.• Identified process improvements and system enhancements, developing strategic initiatives for department.

Green Bay, Wisconsin Area

Researched provider payment disputes submitted for claims processing to maintain or overturn original processing decisions based on applicable guidelines.• Explained payment processing details to providers, verifying claims were processed according to contract and member benefits.• Assisted with development of new associates, ensuring understanding of business objectives and procedures.

Green Bay, Wisconsin Area

Processed claims submitted by medical providers or members according to plan benefits.• Provided excellent customer service to providers and members through timely and accurate claims processing.