Tiffany Miles work email
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Tiffany Miles personal email
As a Clinical Operations Manager with 10+ years of experience in various health care settings, I have developed and demonstrated core competencies in resolution and process improvement, business analysis and strategic planning, vendor and contract management, audits and documentation, and customer relationship management (CRM). I have a proven track record of leading and mentoring high-performing teams, delivering exemplary operations and customer service, and implementing improvement initiatives that enhance efficiency, quality, and profitability.In my most recent role at AIM Specialty Health, I oversaw a team of 12 direct reports, monitored and assessed the volume, source, and type of claims, and coordinated Medicaid rosters against state eligibility data. I also helped the business understand drivers, trends, and product stress points, and built solid, trust-based relationships with clients and stakeholders. Previously, at MultiPlan, I managed complex internal and external operational matters, negotiated contracts with vendors, and ensured compliance with audits and documentation. I am a tenacious problem solver who delivers viable solutions to complex problems, and a catalyst for revenue growth and profitability. I am passionate about applying my skills and expertise in process improvement and CRM to help organizations achieve their goals and optimize their outcomes.
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Manager, Clinical NegotiationsMultiplanChicago, Il, Us -
Manager Ii, Clinical OperationsAim Specialty Health Jul 2021 - Dec 2022Chicago, Il, Us -
Manager, Clinical NegotiationsMultiplan Jun 2016 - Jul 2021Direction and oversight of a team of 12 direct reports, monitoring employee performance to ensure adherence to metrics and managing all aspects of hiring, terminations, annual reviews, and training and performance feedback. Ensure completion of special projects as assigned and lead one on one meetings and team meetings. Monitor and assess overall volume, source, and type of claims including client specific directives, and implementation of corresponding improvement initiatives.Key Roles and Responsibilities:►Focus on resolution and process improvement, fulfilling all obligations while maximizing cost effectiveness, helping business in understanding drivers, trends and product stress points and helping partners attract and retain business.►Leverage data, management information and technology to identify and optimize opportunities to support business strategies and improve results.►Provide instruction, strategy, and direction to negotiators on individual fee cases.
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Government ProgramsBlue Cross Blue Shield Illinois/Hcsc 2013 - 2016Managed stakeholder expectations for BCBSIL Medicaid products. Provided operational assistance and program leadership to further enhance systems.Key Roles and Responsibilities:►Identified, researched, and resolved complex internal and external operational matters.►Coordinated Medicaid rosters against State of Illinois eligibility enrollment data.
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Manager OperationsSedgwick Claims Management Services, Inc 2012 - 2013UsWorked collaboratively to enhance processes and implement initiatives leading to increased profitability. Assessed upcoming projects to forecast projected resource requirements. Implemented conflict-resolution tactics by cooperating with clients and staff to achieve team objectives. Maintained client relationships and contracts.Key Roles and Responsibilities:►Designed performance metrics to provide traceability through organization and advance tactical and strategic business goals.►Analyzed performance data to assess, optimize and elevate operations, targeting current and expected demands.►Created policies and procedures to ensure compliance with best practices, claims management standards, state regulations. -
Manager, Disability Claims UnitCitizens Management Inc 2005 - 2012Steered program oversight and management of claims adjusters for the State of Michigan’s short-and-long-term disability claims programs. Oversite of all aspects of vendor and client vetting, selection, and management. Tracked overall program performance monitoring and reviews.Key Roles and Responsibilities:►Developed and implemented effective training, performance development and succession planning, including creating and implementing a training manual that was previously non-existent.►Formulated strategies for process improvement programs.►Led leadership meetings and communicated program performance status.►Prepared training schedules for new processes and procedures while mentoring team.
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Disability/Quality Review AnalystFord Motor Company/Bartech 2002 - 2005Played key role as member of a Six Sigma process, charged with redesigning the Ford Motor Company Disability Program. Continually upheld and complied with industry standards.Key Roles and Responsibilities:►Recognized for a roll-out implementation of the Disability Program throughout Ford Motor locations in North America.►Provided oversight and direction of efforts of TPA staff with regards to claims management.
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Workers Compensation AdministratorFord Motor Company/Bartech 1997 - 2002Onsite administration of multi-state Workers' Compensation claims for various Ford Motor Company facilities which included litigated, indemnity, managed medical and medical only claims.Key Roles and Responsibilities:►Provided oversight of medical services and medical claims management.►Lead case management meetings to identify modified work assignments; discussion of applicable case law and the impact of various employment laws, regulations and collective bargaining agreement on individual claims.►Forecasted annual workers' compensation liability for individual facilities.►Monitored budget throughout the year and assisted with implementation of cost reduction programs.►Negotiated settlement of claims and coordinated management of litigated claims with in-house and outside counsel.
Tiffany Miles Skills
Tiffany Miles Education Details
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University Of Illinois At ChicagoCriminal Justice -
The Culinary School Of Kendall CollegeCulinary Arts/Chef Training
Frequently Asked Questions about Tiffany Miles
What company does Tiffany Miles work for?
Tiffany Miles works for Multiplan
What is Tiffany Miles's role at the current company?
Tiffany Miles's current role is Manager, Clinical Negotiations.
What is Tiffany Miles's email address?
Tiffany Miles's email address is tm****@****ver.com
What schools did Tiffany Miles attend?
Tiffany Miles attended University Of Illinois At Chicago, The Culinary School Of Kendall College.
What skills is Tiffany Miles known for?
Tiffany Miles has skills like Workers Compensation, Team Building, Training, Claims Management, Insurance, Leadership, Claim, Performance Management, Disability Insurance, Disabilities, Process Improvement, Customer Service.
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