Sandra Aranegui

Experience

• 

  UnitedHealthcare

  Dec 2008 - Jan 2019

  • Project Management for Operational Resolutions: Led projects addressing global operational gaps by developing and implementing process improvements in collaboration with business partners, stakeholders, and client management teams.• Issue Remediation Coordination: Spearheaded the resolution of global issues impacting Group Retiree business, assessing process and systematic breakdowns to identify root causes and coordinating comprehensive project action plans for prevention.• Root Cause Analysis: Conducted detailed analysis on process failures affecting entire member populations, collaborating with senior business partners to develop tailored solutions for both immediate and long-term remediation.• Innovative Process Design: Designed and implemented a pioneering business model for Coordination of Benefits reporting to CMS, adapting to group-specific requests processed through electronic eligibility files.• Stakeholder Engagement and Communication: Maintained open lines of communication with stakeholders and clients to ensure alignment, transparency, and successful project outcomes.• Proactive Risk Mitigation: Anticipated and addressed potential operational failures, ensuring proactive and continuous improvement across processes to enhance service reliability. Show less • Global Operational Failure Resolution: Managed initiatives to resolve operational inconsistencies in Affordable Care Act policy enrollments, ensuring accurate member eligibility and plan integrity.• SWAT Project Leadership: Identified and corrected coverage issues for over 2,300 members with active coverage on inactive plans and PVRCs, leading the business segment’s first SWAT project to resolve these discrepancies. • Billing System Error Remediation: Acted as a key resource in correcting a GIBS billing system error that removed 8,900 members from the CDB eligibility database; analyzed eligibility data and reviewed reprocessed claims following member reinstatement. • Specialized Support for Claim and Installation Issues: Provided expertise in resolving complex installation and claim issues on the IBM AS400 PBM prescription claim platform, supporting seamless benefit access for members. • SOP Development and Quality Control: Authored, reviewed, and corrected standard operating procedures (SOPs) to ensure clarity, accuracy, and alignment with compliance requirements. • CMS and Regulatory Participation: Actively participated in REGTAP and CMS Issuer calls to stay informed on compliance standards and regulatory updates impacting ACA policies. Show less • CMS Guidance Interpretation: Located, analyzed, and interpreted CMS guidelines on National and Local Coverage Determinations to define and justify Medicare Medical Benefit Policies, supporting or contesting internal clinical coverage decisions and claim processing.• Medicare Part D Training Program Development: Designed and delivered training classes on Medicare Part D prescription claim processes, procedures, and guidelines, creating a comprehensive user guide for navigating the IBM AS400 Medicare Part D PBM prescription claim platform.• Web-Based Training for HMO Network Claims: Developed and facilitated web-based training for medical claim procedures specific to the West region’s Medical Group-based HMO networks, along with advanced navigation training for the IBM NICE claim/enrollment/provider platform. • Subject Matter Expertise: Recognized as a Subject Matter Expert for complex scenarios related to medical and prescription claims, enrollment, billing, PCP, and system issues, providing expert guidance on intricate cases. • Documentation and Process Improvement: Created job aids and process instructions to enhance clarity and accuracy in workflows, ensuring alignment with Medicare and company standards. • Pharmacy Account Audit and Correction: Audited and facilitated corrections for pharmacy accounts across Medicare Part D and Medicare Advantage with Part D products, ensuring accuracy on the IBM AS400 Medicare Part D PBM prescription claim platform. Show less

  • Senior Service Account Project Manager

    Oct 2016 - Jan 2019

  • Service Account Project Manager - Exchange Advocacy Operations

    Oct 2015 - Oct 2016

  • Business Process Analyst - Benefit Operations - Medicare

    Dec 2008 - Oct 2015
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  NorthWinds Technology Solutions

  Feb 2019 - Jan 2023

  Program Manager / Scrum Master

  • Team Leadership: Led three cross-functional, geographically distributed teams, implementing the Scaled Agile Framework (SAFe) to ensure alignment with enterprise goals and improve delivery efficiency.• Project Management: Oversaw and managed scope, timeline, quality, goals, and deliverables to support strategic enterprise objectives in developing dental insurance platforms.• Community of Practice Facilitation: Led bi-weekly Community of Practice meetings and workshops, fostering collaboration and skill enhancement among Scrum Masters across the organization.• Automation Implementation: Introduced and implemented Macro Express Pro across the enterprise, developing and maintaining scripts to automate operations for front-end user functions on the Keyspring claims platform.• Strategic Initiatives and Risk Management: Managed key Strategic Initiative and Disaster Recovery projects, focusing on risk mitigation, business continuity, and successful project outcomes.• Continuous Improvement: Ensured continuous improvement in agile practices and team performance, focusing on both process efficiency and product quality.• Stakeholder Communication: Regularly communicated progress, risks, and key updates with stakeholders to ensure alignment and transparency throughout project lifecycles.• Agile Coaching: Provided coaching and guidance on Scrum principles to promote a high-performing agile environment within teams. Show less

• 

  Lover's Rock Productions

  Jul 2021 - now

  Founder

  • Operational Process Development: Develop and optimize operational processes to streamline event production and business functions.• Software and Technology Management: Selected, implemented, and integrated essential software tools for business operations, including website management, payment processing, Atlassian project management (Jira and Confluence), CRM systems, and graphic design software.• Team Leadership: Lead a team of 11 direct reports, providing guidance, support, and development to ensure smooth operations and event execution.• Event Project Management: Create and execute project plans for large-scale community events, including Rocky Mount Fest, with an annual attendance of 18,000.• Festival Development: Founded the Smith Mountain Lake Live Music Festival, a multi-location event held across two counties, celebrating local live music and fostering community culture.• Digital Marketing and SEO: Develop and manage digital marketing campaigns, handled website development, and optimized SEO for maximum reach and engagement. Manage social media for a portfolio of clients.• Community Recognition: Honored with Roanoker Magazine’s 40 Under 40 award in January 2023 for impactful contributions to the community. Show less