Experience

PacificSource Health Plans

• United States
• Insurance
• 700 & Above Employee

• Claims Manager

  • Mar 2018 - Present

  Responsible for all aspects of the operations for the Commercial Claims Department and Coordination of Benefits and Third Party Liability for Government Claims. Establish, monitor, and continuously improve processes and supporting policies and procedures that ensure the timely and accurate processing of claims. Lead multiple teams supervised by Team Leaders to achieve department goals and metrics. Lead and support the Training team within my department. Collaborate with other departments to… Show more Responsible for all aspects of the operations for the Commercial Claims Department and Coordination of Benefits and Third Party Liability for Government Claims. Establish, monitor, and continuously improve processes and supporting policies and procedures that ensure the timely and accurate processing of claims. Lead multiple teams supervised by Team Leaders to achieve department goals and metrics. Lead and support the Training team within my department. Collaborate with other departments to meet customer needs and improve the overall operational efficiency within the company. Manage relationships and performance of vendors utilized for claims processing. Provide coaching and development for Team Leaders and others in the claims department. Develop budgets and manage spending within established budgets. Lead change and encourage innovation and process improvement. Ensure PacificSource’s reputation as a provider of outstanding service by supporting the vision, mission, and values of the organization.

• Claims Team Lead

  • Aug 2017 - Mar 2018

  Springfield, Oregon, United States Supervise and provide guidance to Third Party Recovery Representatives regarding company policies, procedures, and workflow. Manage third party recovery functions for efficiency, timeliness, and quality. Resolve third party issues and oversee tracking and reporting of third party savings. Responsible for hiring, training, coaching, counseling, and evaluating team member performance. Demonstrate effective leadership by coaching to improve individual performance, develop teamwork and team… Show more Supervise and provide guidance to Third Party Recovery Representatives regarding company policies, procedures, and workflow. Manage third party recovery functions for efficiency, timeliness, and quality. Resolve third party issues and oversee tracking and reporting of third party savings. Responsible for hiring, training, coaching, counseling, and evaluating team member performance. Demonstrate effective leadership by coaching to improve individual performance, develop teamwork and team support, manage change and encourage innovation, build collaborative relationships, encourage involvement and initiative, and develop increased vision and commitment to goals in others.



Performance Health Technology

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Claims Supervisor

  • Mar 2014 - Jul 2017

  Salem, Oregon, United States Manage claims team with 17 to 30 analysts. Work closely with other departments to build and foster a good working relationship with our plans. I am responsible for Medical, Dental and Mental Health plans. Monitor very closely inventory levels of claims and service inquiries to ensure we are meeting or exceeding our Service Level Agreements. Maintain and adjust processes and procedures documentation for each plan when needed for contract and benefit changes. Keep open lines of communication… Show more Manage claims team with 17 to 30 analysts. Work closely with other departments to build and foster a good working relationship with our plans. I am responsible for Medical, Dental and Mental Health plans. Monitor very closely inventory levels of claims and service inquiries to ensure we are meeting or exceeding our Service Level Agreements. Maintain and adjust processes and procedures documentation for each plan when needed for contract and benefit changes. Keep open lines of communication with the plans to facilitate business needs and a good working relationship. Work with team members to assist them in their development and professional growth to encourage a productive working environment. Customer service is a large part of my job to facilitate any needs of both internal and external customers. Show less



Regence BlueCross BlueShield of Oregon

• United States
• Insurance
• 700 & Above Employee

• Claims Supervisor of Government Programs Medicare Operations & Billing

  • Feb 2013 - Mar 2014

  Salem, Oregon, United States Work with the Enrollment team of 15 to 40 Membership Accountants and other Supervisors and Depts. to ensure that all Medicare Compliance guidelines are being met and adhered to. Continually work to honor our members and give them the best member experience. I am responsible for the Enrollment, Group Enrollment, Healthcare Capitation Reconciliation, End Stage Renal, and Long Term Care Facility teams. I have implemented and assisted with many new processes and procedures with in my department… Show more Work with the Enrollment team of 15 to 40 Membership Accountants and other Supervisors and Depts. to ensure that all Medicare Compliance guidelines are being met and adhered to. Continually work to honor our members and give them the best member experience. I am responsible for the Enrollment, Group Enrollment, Healthcare Capitation Reconciliation, End Stage Renal, and Long Term Care Facility teams. I have implemented and assisted with many new processes and procedures with in my department as well as other departments. I work with my team to assist them with any developmental and performance opportunities and continued professional growth.

• ASO Claims Team Lead

  • Apr 2011 - Feb 2013

  Medford, Oregon, United States Work closely with a team of 20 plus analysts to assist them in order to better serve our members and take care of their claims in a timely and accurate manner. As well as, working closely with my supervisor and assisting her with follow up items while she is in meetings or out of the office. Setting up and organizing many new tracking systems and following up on these procedures as the ASO Units were just newly assembled to insure that claims were moving thru our system properly. Helping… Show more Work closely with a team of 20 plus analysts to assist them in order to better serve our members and take care of their claims in a timely and accurate manner. As well as, working closely with my supervisor and assisting her with follow up items while she is in meetings or out of the office. Setting up and organizing many new tracking systems and following up on these procedures as the ASO Units were just newly assembled to insure that claims were moving thru our system properly. Helping analysts to know where certain claims and questions needed to be directed until we had a system in place for the new ASO units. Participate in regular leadership meetings in an effort to share our experiences and help our analysts to be able to understand the new way processes are working outside of the commercial claims world.

• Claims Team Lead

  • Apr 2008 - Apr 2011

  Medford, Oregon, United States Trained on Legacy and Facets systems. I was able to step in and take over for my supervisor while she was in FACETS training and attend her meetings and represent her in a manner that was professional and appropriate. Worked closely with each member of my team to guide them thru any claims processing question or needs that might arise. Worked with claims that were performance guarantee such as OMIP, Bledsoe, OTET etc. It is very important that I take each analyst personality and learning… Show more Trained on Legacy and Facets systems. I was able to step in and take over for my supervisor while she was in FACETS training and attend her meetings and represent her in a manner that was professional and appropriate. Worked closely with each member of my team to guide them thru any claims processing question or needs that might arise. Worked with claims that were performance guarantee such as OMIP, Bledsoe, OTET etc. It is very important that I take each analyst personality and learning skills into account in order to be able to guide them in the correct direction. Contact provider’s offices to verify correct information of processing for medical claims. Communication and customer service is a very large part of my job. I enjoy working with people and I am able to explain things in a direct and yet polite manner. Work directly with management to take any actions needed and worked on a team to put in place new processes.

• Senior Claims Analyst

  • Sep 2002 - Apr 2008

  Medford, Oregon, United States Processed multiple lines of business. Verified claims for accurate information and coding. Contact provider’s offices to verify information. Use and understand medical terminology. Self-manager, able to prioritize work in order to accomplish daily requirements and goals. Mentored analysts. Responsible for routing and filing claims to correct destination for timely processing.