At Centene Corporation, I directed provider operations and data management for Florida Medicaid and Marketplace products, supporting claims performance and operations for 75,000+ providers. I led a 205-person organization through eight direct reports and managed a $7M departmental budget.
I designed and implemented an enterprise data validation and control program that reduced provider data errors below 2%. I also strengthened inventory management and reduced backlogs, preventing more than $600K in potential AHCA regulatory fines.
At CVS HEALTH / AETNA, I managed provider relations and claims escalations, configured QNXT provider data tables, and implemented CAQH ProView for Groups to streamline credentialing. Earlier, as Supervisor, Claims at APWU HEALTH PLAN, I reduced pended claim inventory by 33% within the first year and spearheaded a nine-month QNXT implementation.
I began in claims at CAREFIRST BLUECROSS BLUESHIELD, progressing from Customer Service Specialist to FEHBP Claims Adjuster. That work gave me hands-on experience researching and adjusting claims, interpreting benefits, and resolving claim issues.
