Nick Edwards

Experience

• 

  The Warranty Group

  Feb 2005 - Jun 2010

  • Managed and lead a high performing team comprised of 30+ Customer Care Professionals, Claims Adjusters, Quality Assurance Trainers, Team Leads, and Licensed Specialist in a contact center and back-office environment.• Investigated, resolved, and responded to customer, BBB, and State Insurance complaints and concerns in a timely, professional manner. • Led in-depth file review audits of both claims and phone calls to ensure compliance with defined processes and approved all claim payments within the department.

  • Claims Supervisor – American Express Travel

    Aug 2007 - Jun 2010

  • Quality Assurance Trainer & Auditor – American Express

    Feb 2005 - Aug 2007
• 

  CNA Insurance

  Dec 2010 - Mar 2015

  Operations Manager - Claim Reporting

  • Oversaw the work of a high performing team comprised of 20+ employees, including General Clerks, Customer Service Representatives, Interns, Contract Workers, and Quality Assurance Representatives in a call center and back-office environment. • Managed the department's daily and monthly service level agreements related to claim turnaround time, the average speed of answer abandonment rates, and quality guidelines.• Proactively reviewing staff performance to identify training and productivity deficiencies and implement solutions. • Assigned, distributed, and coordinated the daily workflow, allocating resources among multiple site locations to ensure the consistent, efficient, and timely delivery of service while ensuring compliance.• Successfully managed critical operational relationships of 3rd party vendors used by the company. Show less

• 

  Kaiser Permanente

  Mar 2015 - now

  • Worked to elicit and capture functional and non-functional requirements and obtain customer agreements for the NCA Claims Optimization & Platform Enhancements Business Integration Technology Services (BITS) team. • Performed in-depth analysis and evaluation of NCA business systems and processes for special projects, platform enhancements, claims optimization, and change requests. • Developed and present functional business requirements and maintain client support during system development and implementation while maintaining the scope and timeline of each project.• Provided subject matter expertise to each project while working to build advantageous business relationships with strategic business partners impacted by the assigned project. • Created and recommend a variety of changes to existing business processes to drive process improvement. Show less • Elicited and captured functional and non-functional requirements in addition to obtaining customer agreements for the KP Membership Connect Program.• Led and produced user acceptance testing, including test case scenarios, test case development, data preparation, and analysis and test execution. • Provide recommendations on the appropriate solutions-based requirements gathering.• Spearheaded interviews with stakeholders and process owners to correctly define processes, including presentations, process maps, supporting metrics, business requirements, and related impact analyses for 2 tracks of the KPMC Program (Documents Management and Data Warehouse and Reporting).• Added valued input while leading and participating in change management activities associated with process improvements.• Worked in collaboration with leaders and stakeholders to obtain support and buy-in for changes. Show less • Managed project and issue resolution work for the NCA Issue Management teams in the ROC regions and held functional lead responsibility for ROC CRM enhancements and the PSSA Role team. • Led partnership meetings and activities between NCA and MSCC for the ROC region and served as the single-point-of-contact for all claims-related situation from MSCC.• Collected and researched specific client requests for projects, including identifying requirements, gathering workflow data and systems, and reporting specifications. • Provide wide-ranging 2nd and 3rd tier application and process support as needed. • Researched and resolved both technical and functional issues as defined by the prioritization/severity scheme and identified, recommended, and implemented opportunities to drive business process improvement.• Recommended system and process enhancements to improve the operations, quality, and customer experience of the National Claims Administration team. Show less • Directed the work of a team comprised of 35+ Medical Claim Processors, Adjusters, Mail Room Clerks, and Data Entry Clerks in a labor union/labor-management partnership environment.• Led the operations of the National Claims Administration regional claims processing units, including the timely, proper adjudication of claims in line with contractual benefits. • Led the processing of insurance claims in a manner that met operation, financial, and service requirements, including assigning, distribution, and coordination of daily workflow and inventor levels. • Developed and executed strategic and operational business plans for the departments. • Added valued input while participating in department operations modifications and projects while engaging in other areas of the organization to identify and enhance department deficiencies and issues. Show less

  • Sr. Manager, Managerial Consulting

    Jun 2020 - now

  • Business Consultant/Analyst Specialist

    Oct 2019 - Jun 2020

  • Business Process Consultant

    Apr 2019 - Oct 2019

  • Project Manager Lead

    Oct 2015 - Apr 2019

  • Claims Processing Supervisor

    Mar 2015 - Oct 2015