Experience

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  Aetna

  • United States
  • Wellness and Fitness Services
  • 700 & Above Employee

  • Director, Specialty Products, PRA

    • May 2015 - Present

    Key leadership role in the Product & Regulatory Approvals dept with governance of Group Insurance, Dental and Vision (GI), Student Health, Voluntary, Medicare Advantage and other specialty products.

  • Business Project Program Manager

    • Aug 2014 - May 2015

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  The Hartford

  • Simsbury, Connecticut

  • Assistant Director, Strategic Initiatives and Product Delivery, Contract Consulting

    • Mar 2008 - Jul 2014
    • Simsbury, Connecticut

    I am in a key leadership role in Product Delivery, managing a team that supports varying business areas; Product, Underwriting and Sales; in Product Development, Conversion, Implementation and overall contract consulting. I manage a team of employees that draft, file and consult on over 4000 non-standard requests, annually. My position supports the development and execution of some important Group Benefits Strategic Initiatives, to include: Filing, Conversion and Product Delivery operating plans for both Employer and Association Market business. Held previous positions as AD Contract Compliance and Senior Contract Compliance Specialist as well as developed competitive deviation reports for Presale and Implementation Team.

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  ASignature Fence Company

  • West Springfield MA 01085

  • Treasurer, Project Manager, Owner

    • Mar 2006 - Mar 2008
    • West Springfield MA 01085

    • Established business; secured investors and incorporated company.• Contract negotiations with Westover Air-Force Base which resulted in $1 million contract to install custom fencing for the Navy and Air-force baseball fields.• Contract pricing, estimating and cash applications. • Prepared and presented formal marketing proposals for new business. • Project Management of prevailing wage government jobs. • Created Financial Statements and reported activity to investors and to Westover Air- force Base Governmental Auditors.Created Brand and set service strategy models.

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  UnitedHealth Group

  • Hartford, Connecticut Area

  • Fraud Recovery Manager, Medical Claim Data Analytics

    • 2004 - 2005
    • Hartford, Connecticut Area

    • 2 Tier Management Structure: Lead a team of 8 Data Analysts, with 1 Supervisor, and 3 Fraud Investigators.• Featured speaker at the International Claims Association Meeting, detailing fraud detection and aberrant patterns• Integrated individual disability management resolution philosophy into the recovery services process. This strategy resulted in the recovery of $500,000 from onsite negotiations. • Partnered with Network Administration to draft protocols for educating medical providers on how to prevent up-coding and or double-billing. • Led a Six Sigma Initiative to reduce allegation backlog from 30 days to 10 days.• Led a Six Sigma Initiative to reduce the process steps for identifying aberrant patterns. • Authored new data analyst procedures that streamlined the identification process for identifying up-coding in medical claims.• Held a seat at the monthly DOI Meetings and communicated industry updates to department.• Marketed and sold fraud services as a bundled recovery service package.

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  Integrated Disability Resources

  • Bloomfield, CT

  • Group Disability Claims Manager

    • 2002 - 2004
    • Bloomfield, CT

    • 2 Tier Management Structure: Led a team of 10 Claims Analysts, with 2 Supervisors and 2 Medical Consultants.• Integrated individual disability management resolution philosophy into the Group DI forum by training employees on settlement negotiations and strategies, this resulted in a significant increase in reserve release.• Conducted due diligence reviews of new TPA accounts. • Led several project initiatives to review claims and create a managed return to work strategy.

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  MassMutual Financial Group

  • Hartford, Connecticut Area

  • Senior Individual Disability Claims Representative

    • 2000 - 2002
    • Hartford, Connecticut Area

    • Residual disability claims representative specializing in complex, high indemnity residual claims.• Coordinated Return to Work initiative with impairment specialists and rehabilitation coordinators.

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  Unum

  • Springfield, Massachusetts Area

  • Senior Individual Disability Claims Representative and Residual Analyst

    • 1997 - 2000
    • Springfield, Massachusetts Area

    • Residual claims representative specializing in high indemnity, complex residual disability claim management for Reinsurance Company (TPA business/Equitable Life Insurance Company). • Developed new mediation process and implemented in the field.• Field negotiations that resulted in over $5 million in recovery. • Developed Claims Representative Guiding Principles and implemented into on-boarding packet.• Interface with Reinsurance Company to report monthly results and upcoming resolution strategies. • Dedicated to the ERISA Appeals Committee; organized committee meetings, gathered file documentation and presented case to a roundtable for discussion and final claims disposition.• Authored training guide “10 Steps to Relieve Deposition Anxiety”. This tool was used by Claims Representatives to provide them with the details of preparing for a deposition and what to expect during the process.

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  Monarch Life Insurance Company

  • Springfield, Massachusetts Area

  • Residual Individual Disability Claims Representative

    • 1994 - 1997
    • Springfield, Massachusetts Area

    • Specialized in Pre-and Post Disability calculation and analysis for disability claims staff• Conducted on site field financial audits of residual disability claimants.• Designed profiling tools for financial analysis to track residual loss trends. • Educated local staff and senior management on loss findings/opportunities. • Interfaced with Reinsurance companies and developed financial strategies for lagged claims.

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  ABB Combustion Engineering

  • Bloomfield, CT

  • Accountant

    • 1989 - 1994
    • Bloomfield, CT

    • Designed Access Database program that generated a monthly financial statement.• Generated Monthly and Year End Financial Statements • Conducted daily general ledger journal entries and monthly balancing of $200 million dollar accounts.• Managed expatriate accounts and improved international communication efforts.• Transferred foreign currency.