Coordinated enhancement and release deliveries from development department Planned and coordinated system change management process business requirements analysis for technical development Aetna US Healthcare As Claims Examiner adjudicated indemnity medical and dental claims, making benefit determinations in accordance 1996 1999 – with policy provisions and responding to various inquiries via telephone and in writing. TPA of Washington As Manager, Strategic Accounts: Reporting directly to the President, provided on-going 1994 1995 – service to both clients and brokerage community on benefit issues, renewals, proposal specifications, claim and enrollment reporting, etc. on accounts exceeding 1,000 enrollees and/or $100,000 annual revenue Managed claims department, staff of 30 permanent employees, including claims adjudication, customer service, front-end claims data entry, mail room, reception, medical review, reinsurance, training, quality assurance, provider file maintenance, subrogation and pre-certification activities Group Health Cooperative As Claims Consultant: of Puget Sound Managed daily claims flow for designated client groups 1992 1993 Adjudicated medical and dental claims – Contacted State and other payors for claim status Eastlake Administrators information 1993 1994 – Interfaced with medical clinic personnel Conducted workflow analysis and provide recommendations for improvement Cost Care, Inc. As Claims Manager for Western Region: Managed all administrative and operational aspects of 1991 1992 – PPO group health claims processing department. Duties included staff direction and training, information systems analysis, performance evaluations, salary and disciplinary actions, etc. Created increased workflow efficiencies that reduced claims turnaround time from 17 days to 2 days Designed performance-based incentive compensation program which contributed to a 10 per cent increase in productivity Headed system analysis team of end-users and programmers for development and testing of major claims system software upgrade
Coordinated enhancement and release deliveries from development department Planned and coordinated system change management process business requirements analysis for technical development Aetna US Healthcare 1996 – 1999 As Claims Examiner adjudicated indemnity medical and dental claims, making benefit determinations in accordance with policy provisions and responding to various inquiries via telephone and in writing. TPA of Washington 1994 – 1995 As Manager, Strategic Accounts: Reporting directly to the President, provided on-going service to both clients and brokerage community on benefit issues, renewals, proposal specifications, claim and enrollment reporting, etc. on accounts exceeding 1,000 enrollees and/or $100,000 annual revenue Managed claims department, staff of 30 permanent employees, including claims adjudication, customer service, front-end claims data entry, mail room, reception, medical review, reinsurance, training, quality assurance, provider file maintenance, subrogation and pre-certification activities Group Health Cooperative of Puget Sound 1992 – 1993 Eastlake Administrators 1993 – 1994 As Claims Consultant: Managed daily claims flow for designated client groups Adjudicated medical and dental claims Contacted State and other payors for claim status information Interfaced with medical clinic personnel Conducted workflow analysis and provide recommendations for improvement Cost Care, Inc. 1991 – 1992 As Claims Manager for Western Region: Managed all administrative and operational aspects of PPO group health claims processing department. Duties included staff direction and training, information systems analysis, performance evaluations, salary and disciplinary actions, etc. Created increased workflow efficiencies that reduced claims turnaround time from 17 days to 2 days Designed performance-based incentive compensation program which contributed to a 10 per cent increase in productivity Headed system analysis team of end-users and programmers for development and testing of major claims system software upgrade