Engagement Snapshots - PAYER/ 3RD PARTY

• As project manager for a major insurer's new sales tracking software, performed Business Process Reengineering (BPR) for the current practices. Streamlined processes and documented and communicated new workflows. Challenges included a diverse implementation team of IBM technical staff, sales, IT, training, administrative and customer service staff, and representatives from the software company (different from IBM) and a fixed timeline of 20 weeks.

• Led and facilitated a cross-functional team charged with improving an insurer's enrollment process. Team members included representatives from enrollment, finance, sales, and customer service, and activities included traditional process improvement tools: flow charting, cause and effect analysis, root cause development, formulation of recommendations, timeline and responsibilities, and presentation to senior management. Results: 40% of the steps in the process flow chart were identified as "Non-value added" and subsequently eliminated in the redesign.

• Facilitated a team charged with improving Provider Data Processing for a major insurer, as part of a corporation-wide transformation effort. Redesigned processes associated with centralized contract loading for 40 national health plans in the Provider Data Operations center: changed team composition, duties, and accountabilities, and instituted rigorous inventory management.

• Performed various projects to consolidate five regional HMOs into one statewide organization. Developed and tested specifications for a telephone referral unit/call center; managed a crisis claims reduction process (reduction goal was met 11 days before target date); developed forms and policies; and planned space. After consolidation: merged 3 types of nurse reviewers into one position, created a utilization mapping tool (reporting system), and facilitated a team developing a pro-active case management system.

• Along with an RN-MBA consultant, interim leadership team for the HMO-PPO Utilization Management area of an integrated system. Centralized statewide referrals into one call center location, assisted in implementing a new claims processing system (Amisys), moved into new office space, and re-structured the senior nurse operations staff.

• Developed a change management plan for a major insurer implementing a new disability claims engine to be directly used by over 450 staff, and indirectly by hundreds more. Developed training materials and trained change leaders in 4 locations nationally, conducted executive change sessions, created a communication plan, and facilitated claim office negotiations regarding standardizing processes and roles in the new environment.