Experience

Michigan Commercial Insurance Mutual
• United States
• Insurance
• 1 - 100 Employee
• Claims Adjuster

  • Nov 2021 - Present

Packard Claims Holiday, Florida
• Claims Representative

  • Nov 2018 - Nov 2021


Parallon

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Contract Analyst

  • Sep 2013 - Apr 2018

  Coordinate managed care contract implementation activities with Contract Negotiators and Payors Representatives. Model managed care contracts in proprietary Oracle based application. Maintain and control insurance plan information. Liason with Functional Managers and Managed Care Contract Negotiators to address contract administration issues. Model Medicare and Medicaid rate schedules, coordinate with Government Logging and IT. Publish and maintain isurance documnts and stop loss… Show more Coordinate managed care contract implementation activities with Contract Negotiators and Payors Representatives. Model managed care contracts in proprietary Oracle based application. Maintain and control insurance plan information. Liason with Functional Managers and Managed Care Contract Negotiators to address contract administration issues. Model Medicare and Medicaid rate schedules, coordinate with Government Logging and IT. Publish and maintain isurance documnts and stop loss data on internal relational database application. Create ad-hoc reports, provide educational resources and support. Member of Oracle based application implementation team. Show less Coordinate managed care contract implementation activities with Contract Negotiators and Payors Representatives. Model managed care contracts in proprietary Oracle based application. Maintain and control insurance plan information. Liason with Functional Managers and Managed Care Contract Negotiators to address contract administration issues. Model Medicare and Medicaid rate schedules, coordinate with Government Logging and IT. Publish and maintain isurance documnts and stop loss… Show more Coordinate managed care contract implementation activities with Contract Negotiators and Payors Representatives. Model managed care contracts in proprietary Oracle based application. Maintain and control insurance plan information. Liason with Functional Managers and Managed Care Contract Negotiators to address contract administration issues. Model Medicare and Medicaid rate schedules, coordinate with Government Logging and IT. Publish and maintain isurance documnts and stop loss data on internal relational database application. Create ad-hoc reports, provide educational resources and support. Member of Oracle based application implementation team. Show less



Gould & Lamb, LLC

• United States
• Medical Practices

• Business Data Analyst

  • Nov 2012 - Apr 2013

  Work with and support business users to help them understand data and maximize their usage of data to fulfill information needs in line with data standardization efforts. Ensure the consistency, quality, accessibility and share-ability of enterprise information to meet business expectations and attain competitive advantage for the business. Work with business leaders to identify analytic requirements. Familiarity with the business units’ concepts, practices, and procedures. Conduct… Show more Work with and support business users to help them understand data and maximize their usage of data to fulfill information needs in line with data standardization efforts. Ensure the consistency, quality, accessibility and share-ability of enterprise information to meet business expectations and attain competitive advantage for the business. Work with business leaders to identify analytic requirements. Familiarity with the business units’ concepts, practices, and procedures. Conduct interviews with management and other department leaders. Establish and define Key Performance Indicators (KPIs) at the corporate and business levels. Analyze documentation, facts and figures. Perform business analysis and work flow analysis to assess difficulties in reaching goals and to determine a better strategy. Transfer information from management into needed data. Compile a report in an easily understood manner for the business. Comfortable in addressing a diverse group of inside and outside personnel. Act as a liaison between clients and development departments. Document current business processes via process diagrams/work flows and identifying system interfaces. Provide leadership, tools and processes for implementing and maintaining data cleanliness. Establish security, audits, and controls to ensure data integrity of enterprise data. Understand reporting tools and the data architecture to support the reporting requirements. Interpret results using a variety of techniques, ranging from simple data aggregation via statistical analysis to complex data mining. Consider business applications currently being used which may or may not be effective.

• Reporting Services Manager

  • Feb 2009 - Nov 2012

  Management and oversight of the Reporting Services Department: accountable for the activities of MMSEA Compliance Managers. Coordination of customer pre-sale and training activities with National Account Management and Field Sales departments. In charge of interdepartmental communication with Customer Service, Compliance and Recovery Services. Develops departmental policy, procedures, templates, technical specifications and documentation. Investigates, interprets and communicate CMS… Show more Management and oversight of the Reporting Services Department: accountable for the activities of MMSEA Compliance Managers. Coordination of customer pre-sale and training activities with National Account Management and Field Sales departments. In charge of interdepartmental communication with Customer Service, Compliance and Recovery Services. Develops departmental policy, procedures, templates, technical specifications and documentation. Investigates, interprets and communicate CMS Alerts, Mandates, Rules and technical specification changes to internal and external customers. Coordinates interaction with Gould & Lamb Information Services Development staff regarding technical challenges and improvements to database and Internet solutions from a business / customer perspective.


Healthesystems
• United States
• Insurance
• 200 - 300 Employee
• Compliance Manager

  • Oct 2007 - Jan 2008

Sedgwick CMS
• United States
• Medical Practices
• 1 - 100 Employee
• Compliance Manager

  • Feb 2006 - Jul 2007


ESIS

• France
• Higher Education
• 1 - 100 Employee

• EDI Administrator

  • Jan 2003 - Feb 2006

• Workers' Compensation Adjuster, Loss Portfolio Transfer

  • Sep 1999 - Jan 2003


USF&G / St. Paul Companies
• United States
• Insurance
• 1 - 100 Employee
• Claim Adjuster

  • 1996 - 1999