--Analyzed grievances and appeals under the Member Experience section of NCQA for 4+ years.--Participated in multiple audits, both in navigating the audit files, narrating the case history, and answering any questions.--Performed quality assurance on a regular monthly basis, both in reviewing all grievances and appeals for timeliness concerns and reviewing selected grievances and appeals for processing concerns.--Reviewed and reported grievances and appeals to state and federal regulators on a monthly, quarterly,and annual basis.--Designed and updated workflows regarding grievance processing, appeals processing, andlogging/archiving all resources and materials.--Collaborated with multiple departments to plan and enact solutions on reducing grievances and appealoverturns.--Worked closely with SCFHP’s IT Department and Grievances & Appeals database vendor to test newfeatures, report bugs, and generally be aware of how databases get their data for accurate andwidespread reporting.

--Developed multiple workflows to ensure all steps are met for compliance and trained multiple departments to develop detailed reports on all grievances.--Identified and investigated multiple forms of grievances in the medical field, while providing improvements to the health plan’s internal processes and improvements to the member’s understanding of their options with the health plan. --Kept track of 50+ appeals and grievances at one time to see which cases should be prioritized in order to provide timely solutions to members. --Have an in-depth knowledge of how the health plan works in conjunction with state and federal health insurance programs and how that knowledge can be used in the member’s favor.

--Kept track of the rosters, training materials, and statuses of multiple classes at once.--Maintained the equipment and classroom to make sure they cause no issues for the class.--Delivered excellent service to the instructors that teach Cisco's classes.

--Delivered excellent service and hospitality to Google's candidates.--Communicated clearly with multiple parties to make the interview process goes as smoothly as possible--Solved any technical difficulties with Google Video Conference interviews.

--Created and edited multiple pieces of policy for Associated Students.--Edited the bylaws for Associated Students to clarify vague statements and language.--Restructured the internal organization to have more equal workload.--Worked on long-term projects involved with multiple parties, both inside and outside of San Jose State.