Experience

Highmark Health Options

• United States
• Insurance
• 1 - 100 Employee

• Business Solutions Consultant

  • Sep 2020 - Present

  Support Medicaid Business from an Operational Claims perspective, provide operational subject matter expertise, mentor and lead peers, implement process improvements, develop and maintain requirements for high profile system migrations. Support Medicaid Business from an Operational Claims perspective, provide operational subject matter expertise, mentor and lead peers, implement process improvements, develop and maintain requirements for high profile system migrations.



Highmark Inc.

• United States
• Insurance
• 700 & Above Employee

• Internal Business Systems Consultant

  • Dec 2017 - Sep 2020

  Support company Partner Plans, lead workgroup efforts resolving operational challenges, identify and implement process improvements, lead initiatives and high priority escalations.

• Supervisor, Business Analysis,

  • Sep 2015 - Nov 2017

  Supervised and lead a team of Operational Business Analysts, who supported claims operations of a Partner Plan within the insurance industry.

• Partner Solutions Analyst

  • Mar 2015 - Aug 2015

  Develop repeatable processes, support key initiatives, maintain project plans for client implementations and provide onsite support for Go Live events.

• Command Center Services and Planning Business Analyst,

  • Sep 2012 - Feb 2015

  Monitor and support of customer service performance data, gather and analyze production, quality and adherence data, develop project plans and provide key support on high project projects.

• Benefit Coding Quality Analyst

  • Sep 2011 - Aug 2012

  Create and manage departmental training for new hires, perform quality review of internal medical benefits coding applications, support implementation of high project accounts.

• Claims Excellence Auditor

  • Jul 2010 - Sep 2011

  Partner with Business Analysts to develop project solutions, perform audits to validate identified prevention/recovery opportunities, analyze claims processing accuracy, handle production work, maintain reports on the performance of global adjustors against their target goals.

• Provider Service Representative

  • Sep 2006 - Jul 2010

  Service provider telephone inquiries and written correspondence inquiries, process and adjust medical claims, experience with completing analysis to improve processes and identify trending issues.