Ryan Shutt Email & Phone Number

Pittsburgh, Pennsylvania, United States

Pittsburgh, Pennsylvania, United States

- Responsible for managing complex reporting and implementation initiatives for the Claims and Provider Service Operations team. - Work collaboratively with leadership and staff throughout the organization to manage day to day administrative, technical, and operational activities. - Primarily focused on executive level reporting and BPM software.

Greater Pittsburgh Area

- Core business/operations project manager supervising a team responsible for the successful development, testing, and deployment of PEGA Claims Workstation Phase 2 on time and under budget- Act as lead analyst responsible for pulling critical data to support business continuity during the COVID-19 epidemic and fallout- Support Vice President-level report.

Greater Pittsburgh Area

- Lead preparation, elaboration, testing and implementation efforts for Pega Claims Workstation using Business Architect skill set- Assist in project management organization to ensure efficient use of time and resources across multiple departments while working directly with outside vendors via clear, concise, and complete communication- Mentor and assist.

- Support Pega Claims Workstation (CWS) system by handling both day to day operations and analyzing future opportunities for improvement and additional customization- Led use case elaboration sessions for next phase of CWS development by exploring the system’s ability to intake and manage adjustment requests with senior project leadership- Act as direct.

- 2017 ACES Award Winner – September 2017- Implemented Pega Claims Workstation for claims processing on PRPC 7.1 with a focus on process improvement through automation for both pended claims and adjustments- Gathered requirements using scrum methodology and created mock ups for approval for business owners while simultaneously serving as a subject matter.

Greater Pittsburgh Area

- Essential contributor to Pega Claims Workstation development through DCO sessions involving complex discussions of process and business requirements and specifications, flow process modeling, and interacting with SME as a Certified Business Architect- Act as direct support to senior level management regarding high-profile initiatives through research.

Greater Pittsburgh Area

- Apply extensive knowledge and expertise to resolving high priority issues related to inventory levels, claim processing issues, system inconsistencies in a timely, cost-efficient manner using Microsoft Access and Excel programs- Assist Reimbursement, Pricing, Benefit Configuration, Complaints and Grievances, Quality, Member Services, and Provider.

Greater Pittsburgh Area

- Supervise team of ten technical claims specialists to ensure timely completion of projects and assignments- Manage adjustment team inventory levels and design strategic and efficient methods of completion to meet specific targets and goals such as improving claim adjustment turn-around time by 25% within 6 months.- Analyze large-volume projects using.

Greater Pittsburgh Area

- Analyze and adjust medical claims for Commercial, Medicare, and Medicaid members while meeting quality and production standards- Assist member services team by examining issues sent directly via cut logs- Complete larger and more complex projects submitted through the Issues Resolution Tool in a timely manner- Maintain thorough understanding of plan.

Greater Pittsburgh Area

- Work directly with over 1.7 million insurance members and more than 9,000 providers to identify, resolve, and explain any member or provider issue by using extensive, in-depth product knowledge - Maintain organized work list of ongoing issues until resolved- Analyze, understand, and explain insurance claims and coverage plans - Work and communicate with.

Greater Pittsburgh Region

Manage staff of 4-8 employees to ensure all business tasks are completed in a timely and efficient manner while adhering to all safety and health protocols

Master Of Business Administration - Mba, Business Administration And Management, General

Activities and Societies: Graduated in December 2023

Bachelor Of Business Administration (Bba), Marketing