Experience

Elevance Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Business Change Manager Sr.

  • Oct 2020 - Present

• Business Change Manager

  • Mar 2018 - Oct 2020

• Business Relationship Manager

  • Jan 2016 - Mar 2018

  Responsible for resolving issues within the call centers. Ensure the call centers have all necessary information regarding new plan designs, new vendors or new processes and procedures that will impact their staff. Reduce hand off procedures, and improve communication between partnered areas. Partner with Vendor Management Consultants to ensure smooth delivery of processes and information.

• Process Expert Sr.

  • Jan 2014 - Mar 2016

  Responsible for gathering, documenting and implementing system requirements for Medicare Supplement, Medicare Advantage and MAPD for AEP for the IVR's in various states. Point person for issue resolutions on various IVR's, support lights on capabilities. Project Manager for implementing MMP products. Lead for re-branding effort for our NY MMP product. Also responsible for streamlining processes and procedures with a goal of a better member experience. Additional projects as assigned.

• Process Expert II

  • Oct 2011 - Jan 2014



Populus Group

• United States
• Staffing and Recruiting
• 400 - 500 Employee

• Sr. Business System Analyst II

  • Oct 2010 - Nov 2011

  Analyze data, perform benefit validation, testing and other activities required to successfully implement the transition to a new PBM for the Pharmacy Benefit Management (PBM) at WellPoint. Perform testing with functional areas such as Customer Services and enrollment on new benefit implementation and other system initiatives. Responsible for ensuring releases were accurate and information updated accordingly. Analyze data, perform benefit validation, testing and other activities required to successfully implement the transition to a new PBM for the Pharmacy Benefit Management (PBM) at WellPoint. Perform testing with functional areas such as Customer Services and enrollment on new benefit implementation and other system initiatives. Responsible for ensuring releases were accurate and information updated accordingly.



Independence Blue Cross

• United States
• Insurance
• 700 & Above Employee

• Manager

  • May 2007 - Apr 2010

  Was selected to implement the Medicare Advantage programs for Veridign, a subsidiary of Independence Blue Cross. Responsible for set up of new ASO Medicare clients. Also worked on implementing new system. This position had similar responsibilities as the previous position of Manager Benefit Setup Support Services. However, in this position the main concentration was the Senior Market. I worked closely with the VP of the division, marketing, claims and customer service to bring the best… Show more Was selected to implement the Medicare Advantage programs for Veridign, a subsidiary of Independence Blue Cross. Responsible for set up of new ASO Medicare clients. Also worked on implementing new system. This position had similar responsibilities as the previous position of Manager Benefit Setup Support Services. However, in this position the main concentration was the Senior Market. I worked closely with the VP of the division, marketing, claims and customer service to bring the best overall package to our clients.

• MANAGER OF BENEFIT SETUP SUPPORT SERVICES

  • Aug 1992 - Apr 2010

  Oversaw medical benefits coding for all new and existing customers on two processing systems. Managed $1M annual budget and staff of 15-30. Responsible for talent retention and recruitment, business process improvements, and inventory reduction. Increased speed to market of new product designs by 50%. Ensured quality control prior to effective date to ensure benefits were set up accurately. This quality control reduced post implementation issues by 60%. Issued resolution… Show more Oversaw medical benefits coding for all new and existing customers on two processing systems. Managed $1M annual budget and staff of 15-30. Responsible for talent retention and recruitment, business process improvements, and inventory reduction. Increased speed to market of new product designs by 50%. Ensured quality control prior to effective date to ensure benefits were set up accurately. This quality control reduced post implementation issues by 60%. Issued resolution regarding benefit set up. Coordinated with customer service and claims to address turnaround time on inquiries. Reduced number of questions and improved turn around time for inquires by 50%. Set up procedures and reports for SAS70 compliance. Met with outside auditors to ensure benefits were in compliance. Participated in system modifications for the benefits area on both systems. Advised Marketing of benefit application possibility, and potential alternatives. Worked with Legal regarding contract and benefit set up questions for PID. Served as Lead for corporate projects with oversight of 15 Team Leads and support staff. Provided testing scenario preparation and implementation. Working with the IS team, established minimum defects for post go-live, resulting in no defects for Benefits. Participated in cross-functional workgroup to improve service. Built consensus with other business units to improve service to customers, resulting in improvement of customer satisfaction by 30%. Worked with IS to standardize reports to ensure work was delivered and assigned efficiently. Monitored suspends, looked for trends and advised peers of potential training issues. Streamlined processes as result of system modifications. Inventory reduced by 30%. Established production and quality standards to achieve 100% production goals with 100% quality reducing customer complaints.

• CLAIMS SUPERVISOR

  • Jul 1987 - Aug 1992

  Directed daily operations of unit and staff of 30 associates to meet/exceed expected performance. Managed daily review of inventory and determined the category and priority of work. Worked with Unit Leader to cross-train all staff, so rotation could occur during vacations, and unexpected illnesses. Coached and counseled associates. Served as liaison with customer service to enhance better communication between areas. Established new and streamlined existing processes and procedures.… Show more Directed daily operations of unit and staff of 30 associates to meet/exceed expected performance. Managed daily review of inventory and determined the category and priority of work. Worked with Unit Leader to cross-train all staff, so rotation could occur during vacations, and unexpected illnesses. Coached and counseled associates. Served as liaison with customer service to enhance better communication between areas. Established new and streamlined existing processes and procedures. Coordinated with Training Department to establish new courses required to improve job efficiency, and release management for updates to systems and to ensure system was working as required for modification.

• MEMBER SERVICE REPRESENTATIVE

  • Jul 1985 - Jul 1987

  Responded in a prompt, professional and courteous manner to member inquiries and questions regarding plan coverage, account status, claims, and member concerns using established procedures. Used computer to access, update member records, and processed orders. Selected as back up Unit Leader to assist with Supervisor inquiries and issues.