Experience

• 

  Highmark blue cross blue shield

  Jan 2000 - Apr 2010

  Coordinated all activities related to medical benefits and medical claims for nine national dedicated accounts. Managed a staff of twelve employees who were responsible for answering member questions and claim adjudication. Coordinated staffing levels for six units. Performed performance reviews, coaching and counseling sessions. • Four of the nine accounts handled in the unit had a signed contract that had specific target goals for claims accuracy. Ensured that all four accounts had 99% or higher quality, which was exceeding the goal. • Created numerous spreadsheets that were used by all Team Managers reporting to the same Unit Manager for various tracking purposes. • Created a Lotus Notes database to track attendance for six units and later transitioned the Lotus Notes database to a Microsoft Outlook calendar. Show less Coordinated all activities related to medical benefits and medical claims for five national dedicated accounts. Managed a staff of 24 who were responsible for answering member questions and claim adjudication. Coordinated staffing levels for three units. • Successfully reduced service and claim backlogs within a short time period and maintained the appropriate levels. • Completed career coaching with all associates and assisted four associates with meeting their career goals by obtaining promotions within the organization. • Received numerous compliments from Highmark members and group administrators. Show less

  • Team Manager Dedicated Accounts

    Mar 2008 - Apr 2010

  • HPO Training Lab Supervisor

    Feb 2006 - Feb 2008

  • Team Manager

    Nov 2002 - Feb 2006

  • Technical Assistance

    Oct 2001 - Nov 2002

  • Member Service Representative

    Jan 2000 - Oct 2001
• 

  Millennium pharmacy systems

  Aug 2010 - Sept 2011

  Customer service supervisor

  Directly responsible for a staff of 10 customer service representatives and assist with managing the remaining 20 customer service representatives. Coordinate schedules for all customer service representatives to ensure coverage for three eight hour shifts. Review employee timecards, make corrections to timecards in payroll system and approve timecards. Recruit, interview and select qualified candidates. Create and present performance reviews, coaching and counseling to employees. Investigate and respond to escalated issues from external customers and Millennium employees. Project management. •Responsible for writing SOP’s and presenting the finalized document•Actively participate with recruiting, interviewing and selecting qualified candidates •Created an interview guide for conducting customer service interviews Show less

• 

  Highmark health

  Sept 2011 - Oct 2016

  Support business units, conduct analysis and interpret system requirements. Communicate effectively with management, steering committees, project sponsors and subject matter/technical experts across a diverse work environment. Analyze data, use project management techniques and methods and develop business solutions. Assist Payment Integrity team with meeting $10M recovery and avoidance goals. • Successfully recovered $5000 within the first few weeks of joining the team• Collaborating with vendor to achieve $1M recovery by the end of 2015• Taken over accountability for duplicate payment review Show less Coordinate the day to day activities of the CCA unit and ensure collaboration between the customer care advocates and health/wellness coaches. Monitor and assure acceptable levels of performance, productivity and quality are met for all personnel. Coach and mentor employees. Complete administrative tasks such as, performance reviews, time and attendance, training requests, system access, move requests and disciplinary action. • Successfully implemented and executed a new Customer Care Advocate model in 2013 resulting in both pilot clients purchasing the model for 2014• Positive ongoing collaboration with numerous areas, including but not limited to; HEP, HPO Change Initiatives, FBOA, Call Center Platform Modernization, National Client Implementation and Administration, HPO Command Center Show less

  • Business Analyst

    Mar 2015 - Oct 2016

  • Customer Service Team Manager

    Sept 2011 - Mar 2015
• 

  Highmark blue cross blue shield

  Oct 2016 - Nov 2018

  Supervisor case management support

  Supervise and coordinate the day-to-day activities of the non-clinical support staff for case management. Select, develop and continuously coach staff to the highest level of performance. Coordinate with managers and directors in case management as needed to ensure adequate non-clinical coverage. Collaborate with Talent Management team to identify candidates for open positions, interview and select qualified candidates. Plan, organize and direct staff in the day-to-day operations. Monitor and manage daily requests to ensure clinical team needs are being met. Show less

• 

  Highmark health

  Nov 2018 - now

  Manager clinical support team

  Oversee and manage a team that governs the day to day activities of the Clinical Support team, which includes monitoring workflow, resource allocation and process compliance. Responsible for initiating and managing workflows for internal and external customers. Ensure compliance with all regulatory requirements, including CMS, DOL, DOH and NCQA requirements. Manage and coordinate change management activities while maintaining excellent operational results. • Selected to be one of two people in the organization that reviews and approves automation projects submitted to the corporate automation and process improvement inbox to move forward in the automation process. • Actively participating in multiple automation and process improvement projects to enhance how members are identified for case/disease management and insure members admitted to the hospital are contacted timely.• Successfully oversaw the creation and deployment of three automation projects resulting in a reduction of staff for an anticipated annual savings of $216K. Show less