Nationwide Health Plans,
Manager, April 1999 - June 2001
Administration (Member Services), Mailroom & Records Departments
Job Requirements
Oversee operations related to Member eligibility and premium maintenance, support field producer requests, records retention and handling of incoming/outgoing mail.
· Interview and hire qualified candidates to fill open positions as needed.
· Provide training and guidance to processing complex and exception member requested changes.
· Ensure adherence to Corporate Policy related to Human Resources, Policy and Procedures, and expected service level guidelines.
· Motivate through coaching, feedback and positive reinforcement of team members.
· Perform quarterly and year-end performance evaluations.
· Provide individuals guidance, counseling, tools and opportunities to fulfill their professional development goals.
· Act as subject matter expert supporting IT related projects.
· Increased departmental morale through my management style.
· Increased department’s overall efficiency and value by introducing cross-training across pre-existing boundaries, making it possible to reduce staffing requirements by 2 FTEs.
· Established discounted corporate rates for services provided by California Overnight, FedEx and UPS.
CalFarm Insurance Company,
Business Analyst, October 1996 – April 1999
Sr. Business Analyst, June 2001 – April 2004
Work with a variety of personnel from functional areas, IT, and executive level management. Responsible for identifying and analyzing system issues, process deficiencies, prioritize assignment of work requests based on urgency and/or impact to business, and bridge the gap between end users and IT.
· Interpret data provided in customized reports, test results, end user input, and other identifiable trends.
· Quality Assurance testing and validation.
· Interview end user to define and document request to a tangible end result.
· Provide expert consultation to marketing team members during Planning of new products/services.
· Provide input and recommendations to IT personnel during programming effort.
· Create test matrices and validate test results.
· Communicate system changes to affected areas prior to implementation.
· Provide Adhoc reports on demand.
· Prepare Policy & Procedure documents
· Provide training
· Attend annual Marketing Planning & Strategy conferences; providing expert consultation of system capabilities and high-level feasibility of planned activity.
· Created master reference document used by multiple production areas, IT, and analysts in multiple facilities.
· Spearheaded installation of online edits to prevent common user errors from occurring.
California Farm Bureau Federation,
Lead Processor / Supervisor, June 1989 – October 1996
Process changes to member’s Certificates as dictated by Company Policy based on review of daily, weekly and monthly reports. Responsible for all customer change requests and complex adjustments. Responsible for ensuring all customers maintained their Farm Bureau membership, in accordance with the California Farm Bureau Federation and local County Farm Bureaus.
· Authorized to approve exceptions to Company Policy when warranted.
· Supervised 4 night crew staff positions
Blue Shield of California
Claims Processor & Adjustor, March 1986 – June 1989
Respond to written and telephone inquiries from beneficiaries, care providers, medical insurance underwriters, and the Social Security Administration. Resolve processing errors, provide clarification of billing procedures, determine eligibility of proposed services, and answer general requests for information. Review initial appeals of denied claims and determined acceptance or denial of claim payment based upon additional information supplied.
· Earned weekly incentive checks for exceeding production and quality standards.