Pmhs Pps Provider Selection Fallout External Data Selection Management Team resume example with 10+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000
Cell:
resumesample@example.com
Professional Summary
Outgoing, self motivated team player eager to contribute dynamic customer service, team building, and organizational skills towards supporting the objectives of an organization that rewards reliability, dedication, and solid work ethics with opportunities for professional growth.
Skills
CQI analysis
Organized
Multi-tasking
Workflow analysis
Microsoft, Word, Excel
EDSM/CQI Analytics
PMHS,PPS, and HCPM knowledge
Critical Thinking
Root Cause and data analysis
Work History
PMHS/PPS Provider Selection Fallout-External Data Selection Management Team, 05/2013 to Current CIGNA – City, STATE,
Maintain proficient knowledge of all work streams to assist in identifying opportunities to improve the match rate and/or eliminate provider selection fallout for PCS, PPS, and HCPM.
Critical thinking and root cause analysis.
Working knowledge of microsoft, excel, word, power point, visio, QMF, CPF/PWB, PMHS, PPS, Facets, HCPM, Itrack, Webex, CQI EDSM Analytics, SIPOC.
Mapped process activities to desired outcomes to
rectify operational inefficiencies.
Documented business processes and analyzed procedures
to see that they would meet changing business needs.
Partnered with all matrix partners on CQI projects.
Provided complete meeting support including scheduling, preparing
materials, and taking notes.
Created reports and presentations.
Coordinated special projects and managed schedules.
Made proactive recommendations based on system
knowledge and analysis to improve performance and meet business goals.
Provided subject matter expertise in PMHS Provider
Selection.
Monitored timelines and flagged potential issues to be
addressed with offshore partners.
Collaborated with matrix partners onshore and offshore.
Offer research, attention to detail and organizational
and problem solving skills.
Review all documentation for accuracy, quality and
compliance.
Take corrective action to restore and/or maintain
quality standards.
Performed system analysis, documentation, testing,
implementation and user support for platform transitions.
Resolved or escalated problem tickets to resolve user
issues.
Demonstrate ability to lead and motivate team.
Provide coaching and training for onshore and offshore partners.
Maintain proficient knowledge of all work streams to assist in identifying opportunities to improve the match rate and/or eliminate provider selection fallout.
Continued development of customer centricity.
Provided training/coaching to onshore and offshore partners.
Partner and volunteer with Netops Cultural Workgroup Committe and Bamboo Change Management Workgroup.
PMHS Provider Selection Fallout-External Data Selection Management Team, 07/2012 to 05/2013 CIGNA – City, STATE,
Ensure the processing of manual fallout and deliver a highly satisfying customer outcome through accurate provider selection.
Maintain departmental standards for timeliness.
Deliver excellant performance results month over month.
Exceeding departmental metrix all year.
Self motivated and action oriented.
Producing 10-15% above the in office baseline goals.
Processed an average of 34 claims with a baseline goal of 26 claims per hour.
Subject Matter Expert for PMHS.
Proactive identification of non value work flow steps and or non workable scenarios that can be eliminated from manual process or systematically processed without manual intervention.
Excellent understanding of end to end selction process including portico, insight and other fallout tools.
Promoted a positive working environment including relationships with matrix partners, peers, and management.
Displayed required professional behaviors and core competencies supporting new customer centric model for Net Ops and EDSM.
PMHS Provider Selection Fallout- External Data Selection Management Team, 2011 to 07/2012 Kelly Services – City, STATE,
Education
Certified Nursing Assistant: Health care, Expected in 2004 Georgia Northwestern Technical College - 265 Bicentennial Trail Rock Spring, GA 30739 GPA:
GED: , Expected in 2004 Georgia Northwestern Technical College - 265 Bicentennial Trail Rock Spring, GA 30739 GPA:
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Resume Overview
School Attended
Georgia Northwestern Technical College
Georgia Northwestern Technical College
Job Titles Held:
PMHS/PPS Provider Selection Fallout-External Data Selection Management Team
PMHS Provider Selection Fallout-External Data Selection Management Team
PMHS Provider Selection Fallout- External Data Selection Management Team