Sheila Hill Email & Phone Number

Remote

Telework

• Implementation Manager, Transparency
• Implementation Manager for new Transparency in Coverage PMO ensuring compliance of legislative and regulatory mandates.
• Work closely with PMO Leadership, legal & compliance teams, sales teams, and key operational stakeholders to share implementation status, obtain unique branding elements, and ensure market, Customer, and Line of.
• Develop policies and Standard Operating Procedure (SOP) for PMO-level ownership and responsibilities, Machine-Readable File (MRF) Exception Process, and MRF URL Distribution Process to customers.
• Obtain and share User Interface specifications and documentation for all versions of the Cost Estimator tool.
• Collaborate with Learning & Performance to develop and deliver training for Customer Service Representatives (CSR) to assist members using the new Cost Estimator tool.

Telework

• Set direction for quality and initiative projects on the business management team.
• Led HEDIS Modernization & Automation Task Force including Agile work, leadership reporting, and prioritization.
• Proactively developed quality activities aligned with company strategies and values.
• Subject matter expert (SME) on aspects of the business management team while developing and influencing business strategies.
• Managed day-to-day operations of the department budget including working with business partners and budget owner.

Telework

• Increased Automatic Claim Adjudication (AA) through detailed result fluctuation analysis and the use of RPA and Business Process Redesign (BPR), where possible.
• Triaged, assigned, and prioritized RPA backlog for implementation using business need, overpayment/underpayment impacted dollars, unique customer benefits, tactical and strategic solutions, legislative requirements and.
• Attended meetings with business partners to share RPA claim adjudication abilities, systemic solution options, interfacing upstream and downstream applications, production processes, current backlog and to answer.
• Worked closely with RPA claim adjudication vendor to share new processes, documentation standards, prioritization of work, install schedule, audit results and other important information.
• Established, enforced, and updated policies keeping business agile and responsive to changing documentation requirements.

Telework

• Increased Automatic Claim Adjudication (AA) through detailed result fluctuation analysis and the use of RPA and Business Process Redesign (BPR), where possible..
• Triaged, assigned, and prioritized RPA backlog for implementation using business need, overpayment/underpayment impacted dollars, unique customer benefits, tactical and strategic solutions, legislative requirements and.
• Responsible for meeting and exceeding automatic adjudication goals to drive down costs stemming from FTEs, rework and changes to Compliance / Regulations / Legislation
• Attended meetings with business partners to share RPA claim adjudication abilities, systemic solution options, interfacing upstream and downstream applications, production processes, current backlog and to answer.
• Worked closely with RPA claim adjudication vendor to share new processes, documentation standards, prioritization of work, install schedule, audit results and other important information.
• Established, enforced, and updated policies keeping business agile and responsive to changing documentation requirements.

Telework

• IVR Business Content Manager- IVR Business Release Manager
• Manager with Aetna's Integrated Voice Response (IVR) department for multiple Agile Scrum Teams consisting of 100% telework staff.
• Led team to defect reduction of 80% in just 6 months, then by 100% the following year.
• Developed strategic solution for implementation days, times, and activities effectively reducing annual salary expenditures by over $200,000.
• Developed team member’s skills for their roles and in succession planning.
• Ensured Scrum teams delivered expected value to the business on time and within budget including avoidance of Scope Creep.

Telework

• Senior Project Manager (SPM) and Agile Certified Scrum Product Owner (CSPO) with Aetna's Integrated Voice Response (IVR) department for multiple Agile Scrum Teams consisting of 100% telework staff.
• Ensured Scrum teams delivered expected value to the business on time and within budget including avoidance of Scope Creep.
• Collaborated with IT developers and architects, testing, and quality teams to ensure project objectives were met.
• Frequently requested by senior leadership, developers, QA testing lead, other application business members, and overall project teams to provide adjudication and product guidance on projects not assigned to me or my.
• Twice assigned to replace SPM at the last minute for two different high-profile projects due to volume and complexity of issues found during testing and production implementation to get projects back on track and.
• Twice assigned to take over as CSPO for two struggling Scrum teams to reduce defects, increase velocity, and take on larger projects with more story points.

Fort Wayne, Indiana Area

• Worked with many National Accounts customers, brokers and consultants, customer service, and claim adjudication teams to exceed quality standards following each Customer's unique plans of benefits.
• Identified as the site Subject Matter Expert (SME) for Health Systems including hospital vertical, custom networks, reciprocity requirements, and plan design.
• Frequently requested by sales teams to be the PSL for multiple complex customers regardless of site support.
• Worked with implementation teams, account teams, and Standards Management Unit (SMU) during plan design providing guidance regarding what benefits could be systemically adjudicated and which were outside of.
• Participated in pre-sale finalist presentations and site visits; received praise from customers, internal sales teams, and consulting firms regarding clarity and content.
• Coordinated site audits by streamlining introduction, management, and closing of external audits; recognized by management for creation of audit response repository so response research wouldn't have to be duplicated.

Fort Wayne, Indiana Area

• Met quality and performance Key Performance Metrics (KPMs) including close monitoring of results and downtime.
• Managed both separate and multi-functional teams of Claim Processors and/or Customer Service Representatives; responsibilities included results management, training, feedback/scorecards, and assignment delegation.
• Led or participated in over 200 interviews of potential new hires and was on-site supervisor for over 50 trainees.
• Assisted Learning and Performance (L&P) area with updates of training curriculum.
• Worked collaboratively with multiple teams within my site as well as acting as SME for other Aetna teams regarding quality claim adjudication, customer service staffing allocations, and backlog management.
• Managed off-shore claim adjudication teams from two different vendors while simultaneously managing on-shore claim adjudication team.

Fort Wayne, Indiana Area

• Met quality and performance Key Performance Metrics (KPMs) including close monitoring of results and downtime.
• Managed off-shore claim adjudication teams from two different vendors while simultaneously managing on-shore claim adjudication team.
• Balanced work between off-shore vendor teams and all on-shore teams including my own to ensure that all teams had enough work to maintain productivity and that backlogs remained within the TAT guidelines for local.

Fort Wayne, Indiana Area