Successful Six-Sigma process claims optimization project to ensure Government mandated requirements were met.•Received a referral to work at International SOS.

Created, updated and audited fee schedules (Hospital, and all commercial lines of business), for the Q-Blue and NASCO systems. •Implemented, created and revised work flows, and utilized Six Sigma knowledge to improve process workflows. •Used CMS portal to manage business requirement documents and special projects. •Performed contract configuration on NASCO, BCL, TRIZETTO, HSII and Q-Blue systems. •Resolved Q-Blue Plogs and performed root cause analysis. •Identified opportunities to replace manual processes and interventions with technology.•Achieved quality and accuracy standards established for functional processes performed in the day-to-day operations.•Created and implemented a Quality Assurance program for the Reimbursement Department. This program reduced the number of reimbursement errors by 30%. •Used Microsoft Access to query the back end of Q-Blue audit the fee schedules in the Q-blue system.•Resolved FACETS reporting errors (version 4.2).

Performed operational audits across multiple business units. •Used Six Sigma Green Belt tools to lead process capability measurement activities related to the Benefit Utilization Delivery System as well as other associated transactional core processes. •Worked on formal projects and applied Green Belt measure and improvement tools to help define the problem and create the best possible solution under statistical control. •Interacted with multiple business units to obtain clearance to perform operational audits, resulting in departmental readiness to perform the audits.•Using Green Belt capabilities and Black Belt training, increased process capabilities in operational audits across all lines of business to reduce defects in claims operations by 10%.•Participated in the Six Sigma Project to reduce the number of co-payments on SNF claims. A minimum cost savings of $500,000 will be realized during the fiscal year.•Utilized MINITAB and Microsoft Excel to generate reports for upper management.•Audited claims and reduced the defect ratio by 23%.

Supervised one direct report and 25 indirect reports. •Developed and implemented a Quality Assurance Program for all Enrollment activities. •Developed and maintained a policy and procedure manual. •Responsible for maintaining and monitoring the program and generating reports to senior management. •Performed trend analysis of quality review data to identify areas for improvement and training. •Hired and trained quality assurance analyst. Participated in Six Sigma projects as needed.•Implemented the Quality Assurance Program for the Enrollment Department. As a result, the error rate for the department was reduced from 15% to 5% during the 2nd quarter of 2003. •This soft savings associated with the reduction of errors is less customers writing or calling to HIP to have their demographic information updated and the generation of less ID cards.•Used Six Sigma to reduce the cycle time for terminations. •By reducing the processing time from 7.46 days to 2.25 days HIP will have an estimated cost savings of $100,000 - $300,000 dollars a year. This operational change impacted HIP's internal processing time, standard operating procedures and workflows. •Reduced the number of claim that should not have been paid after the termination date.•Reviewed the process for the zip code system enhancement and reduced the number of defects. As a result, there was a 5% reduction of returned mail and reduction in the volume of customers calling HIP to change their demographic information. •Received Six Sigma Black Belt training and Green Belt certification.•Established controls to ensure the departmental compliance with the Sarbane-Oxley Act. As a result, the Enrollment Department passed internal controls and is in audit compliance

Facets expert who supported five customers on the FACETS software for Billing, Capitation and Commissions. •Conducted problem analysis and system testing. •Managed over 1 million lives via FACETS on various enterprise platforms. •Recreated customer environments and developed custom scripts for FACETS upgrades.•Worked with programmers to fix programming issues and participated in the upgrade of the next FACETS module release.•Traveled to customer sites to facilitate the transition and implementation to the FACETS environment.•Used SQL to query the data tables (back-end), of FACETS to recreate the client's production environment. •Performed complex business and client requirement analysis using SQL and Microsoft Access.