Experience

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  The Club at SpurWing

  • United States

  • Outside Member Services

    • Apr 2024 - Present
    • United States

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  Crane Creek Country Club

  • Boise, Idaho, United States

  • Outside Member Services

    • Apr 2024 - Present
    • Boise, Idaho, United States

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  Troon

  • United States
  • Hospitality
  • 700 & Above Employee

  • Supervisor Outside Services

    • May 2023 - Apr 2024

  • Outside Services at Rio Verde Country Club/Troon Golf

    • Oct 2022 - May 2023

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  Retired - Everyday's a Saturday

  • Retired

    • Sep 2021 - Dec 2022

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  Puget Sound Energy

  • United States
  • Utilities
  • 700 & Above Employee

  • Manager, IT Management Services

    • Feb 2018 - Nov 2021

    Directs team responsible for providing cross-IT strategic services related to performance and value measurement, IT communications, branding, marketing, workforce management, process improvement, and governance. Oversees development of policy, process and initiatives on workforce management, career development, succession planning,and management development in line withworkforce/learning and development strategies. Manages broad range of operating and performance practices and measures to support successful delivery of operational and financial performance aspects of annual and multi-year goals and objectives for Office of the CIO. Drives business excellence by overseeing planning, development, analytics, process improvement coordination, data integrity, tracking, reporting, multi-level reviews, and associated technology.

  • Manager, Claims

    • Jul 2014 - Feb 2018

    Directed all aspects of loss control, claims investigation and activities of defense counsel in litigation actions; and directed department strategy related to budget to meet corporate metrics and goals.  Oversaw department budgetary decisions, including review and approval of contracts regarding indemnification matters, selection of outside experts and vendors, hiring, and purchasing goods and services. Led staff of professionals responsible for investigation and resolution of tort claims against company to ensure claimswereinvestigated timely and thoroughly with adequate supporting evidence and documentation.Provided employees with coaching, feedback and development opportunities, setting clear expectations and holding employees accountable for performance as well as safety goals and targets. Established consistent application of processes and procedures related to investigation strategy, case management, and documentation.Reviewed and approved third-party claims within commitment authority.Negotiated and resolved escalated customer claims and claims involving significant potential exposure or risk; and reported on trends and results, using data to manage budget and recommended solutions as appropriate.Set strategy and direction for cost-recovery efforts related to costs incurred from damage to company Infrastructure through collections and billing activities such as associated legal consultation.  Collaborated with internal and external stakeholders, business partners, and peers on claim-related matters, establishing and maintaining working relationships with service partners on claim-related matters. Interfaced with senior management as necessary and appropriate on matters involving significant potential exposure or risk of loss.

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  The Polyclinic

  • Greater Seattle Area

  • Manager of Claims Operations

    • Jul 2011 - Jul 2014
    • Greater Seattle Area

    Managed a diverse, cross-functional team comprised of claims processors, customer service, claims auditor, application analysts and senior database analysts for the Medicare Advantage Claims Operations department at Physicians Care Network/Polyclinic. •Was responsible for claims payment, EDI, Claims system upgrades, vendor management, project management, overpayment recovery, training and procedure development to ensure continued claims delegation keeping within Medicare performance standards.•Was responsible for external health plan initiated audits and regulatory reviews. (HEDIS, CMS) including resolution of audit findings.•Managed all aspects of claims processing systems including software vendor management, EDI transactions and increase auto-adjudication rates, fee schedule development, benefit maintenance, and configuration, membership eligibility, provider contract and regulatory implementation. •Recognized as a unique, technical expert and problem solver as a Subject Matter Expert, providing insight into potential solutions that create value and improve business performance. •Established and maintained excellent health plan, provider, member and outside vendor relationships. •Established short and long-term (annual) department goals in alignment with strategic goals and objectives.•Facilitated business operations meetings with health plans and software vendors.•Managed EZCAP, EZEDI and EZNET claims processing and web portal applications and other adjunct database systems.•Managed the development of Board metrics, dashboard and provider reports.•Served as a resource to other initiatives in support of data gathering, reporting, analysis and distribution of data to support company business.•A recognized strong team player known for consistent delivery of quality services. •Managed work plans, schedules, budgets, coaching, hiring and termination of direct reports.

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  Northwest Administrators, Inc.

  • Manager Health & Welfare Claims Department

    • Sep 2009 - Jul 2011

    •Responsible for management and oversight of the Health and Welfare Claims Department including Pre-processors, customer service and the file room. •Ensured the timely processing of claims and compliance with industry practices and applicable federal regulations. •Prepared statistical reporting, analysis and recommendations.•Set and managed department goals.•Managed a staff of 44 claims professionals including supervisors, claims processors, benefit specialists and administrative support personnel. •Worked with internal customers to ensure service level agreements are met.•Responsible for developing the supervisors and exempt direct reports, providing professional development opportunities through work assignment and special projects.•Implemented an overpayment recovery process that tracks and trends the root cause of overpayments to help identify areas that need improvement.

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  Premera Blue Cross

  • Team Lead/Supervisor

    • Mar 2008 - Aug 2009

    •Participated in the LEAN Leader certification program.•Established business priorities and initiatives, project cost and revenue, managed client satisfaction.•Developed annual business plans specific to area of responsibilities.•Developed and lead business projects.•Organized, controlled and managed multiple teams with related tools, technologies and associate expertise.•Defined and implemented associate development initiatives.•Managed work plans, schedules, and budgets, responsible for coaching, hiring and termination of direct reports.•Performed associate administrative functions, e.g., evaluations, promotions, hiring and terminations.•Collaborated with other business management to ensure business targets were met.•Managed clients outsourcing operational relationships by meeting contractual requirements and service levels.•Supported communication and account management plans.•Managed to quality standards and production requirements.•Supported marketing and sales activities. •Established monthly departmental goals, objectives, and expense and revenue projections.•Defined process improvement requirements, associate development initiatives, performance reporting requirements.•Collaborated with other departmental Leads to ensure cross-functional capability, a consistent application of administrative functions, to define and mitigate potential business risk.•Created resource management plans and communication plans.

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  Premera Blue Cross

  • User System Analyst/AIT

    • Dec 1994 - Aug 2007

    •A senior member of the Acceptance and Integration Testing team (AIT).•Subject matter expert on multiple aspects of core processing system. •Lead on testing efforts for large projects.•Proactively led, and advised business and project partners during the development of design specifications and requirements, to support the desired business goals and outcomes.•Conducted and coordinated research and analysis to evaluate internal and external impacts related to system modifications. •Business point of contact for testing.•Worked with project managers, business analysts, and I.T. to help ensure requirements were gathered from business partners/customers that identified a project’s testing requirements and risks. •Developed and maintained Access databases and training of fellow AIT team members. •Created Ad-Hoc reports using Access.•Responsible for researching technical and functional specifications from the Blue Cross Blue Shield Association, and business partners, to develop test plans, configuration updates, business requirements and work requests to support system upgrades and enhancements as they relate to ITS/BlueCard on the Facets core processing system.•Attended various offsite conferences held by the Blue Cross Blue Shield Association and TriZetto.

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  Spears Manufacturing Company

  • sylmar california

  • Customer Service Manager

    • Jun 1990 - Oct 1994
    • sylmar california