Business Process Manager

• Jan 2022 - Present

Business Process Manager - Process Improvement

• Feb 2017 - Jan 2022

- Manage change implementation process for key business units/stakeholders to help achieve business objectives and increase their change agility- Manage external vendors as needed to assure project objectives are aligned- Project manager of complex, large scale, cross-functional initiatives to ensure programs are delivered on time with an exceptional degree of quality- Leads development of project cost plans. Tracks actual costs against budget to ensure the realization of expected value from resource usage.- Identify areas for process improvement or processes that are unproductive, time consuming, and/or inefficient and communicate that information to management. - Define and drive strategic, operational, and organizational improvements for the department.

Sr. Quality Specialst

• Nov 2016 - Mar 2019

Identify areas for process improvement or processes that are unproductive, time consuming, and/or inefficient and communicate that information to management. Defines and drives strategic, operational, and organizational improvements for the department. Encourages informed risk-taking and acts as a catalyst for innovation; generates practical, sustainable and creative options to solve problems and create business opportunities, while maximizing existing resources. Responsible for leading the assembly and preparation of Medicaid State Fair Hearing summary of Evidence documents as well as coordination and facilitation of State Fair Hearings. Experience effectively interacting with staff/management across multiple departments and levels, including executive leadership. Responsible for leading and presenting presentations on behalf of the department. Responsible for appeals and grievances that are appropriately identified and processed in adherence to the Centers for Medicare and Medicaid Services (CMS) guidelines and plan policies. Participate in department initiatives related to NCQA and EQRO audits. Serve as the subject matter expert for managing complex appeals. Manage workflow to meet department, Plan, State, and company goals and deadlines. Investigate and resolve high level complaints, grievances, and member appeals in accordance with State and/or Plan regulatory guidelines. Demonstrates the ability to create and communicate a business case by analyzing situations, making sound decisions, anticipating obstacles and developing alternative courses of action.Attend member meetings to represent Appeals and Grievances and share any new issues/changes that may be impactful to the member and others in relation to Government Programs. Establish and maintain professional relationships with Plan contacts. Serve as a subject matter to proficiently train and guide staff. Maintains positive effective relationships with internal and external customers.

Business Analyst II

• Jul 2013 - Nov 2016

Work with internal teams regarding the implementation of several projects. Updated Stakeholders onproblem status and ensured speedy resolutions. Perform the full systems life cycle involving designing,coding, testing implementing, maintaining and supporting application software. Elicit and documentbusiness requirements in support of business operations. Serve as a liaison between the businesscommunity and the IT organization in order to provide quality technical solutions to meet user needs andinitiatives. Perform quantitative analysis or data discovery activities. Performs daily technical routineassignments in an effective timely manner. Perform internal administrative functions involvingconducting in depth research. Complete HCA Write off Log (Underwriting Log ) monthly on policies thathave terminated and still have outstanding balances. Experience with spreadsheet based data analysis anddescriptive statistics

Senior Claims Examiner

• May 2009 - Jul 2013