Open to opportunities

Sherlisa Obbo

@sherlisaobbo

Healthcare claims operations leader with 25+ years in Medicare/Medicaid, driving compliant, high-volume performance through data and systems.

United States

Message

What I'm looking for

I’m looking to lead compliant, high-volume Medicare/Medicaid claims operations—building teams, owning SLA/KPI performance, and partnering across IT/configuration to improve turnaround time, accuracy, and CMS outcomes.

I’m a dynamic healthcare operations professional with 25+ years of progressive leadership in health insurance and managed care, with a proven record driving high-volume claims operations across Medicare, Medicaid, and Medicare Advantage programs. I’m expert in HealthRules Payor (HRP), QNXT, and Advantasure/IKA, with deep knowledge of CPT, HCPCS, ICD-9/ICD-10, COB/TPL, CMS compliance, and SLA-driven performance management.

In recent roles as “Associate Director, BPaaS,” I directed end-to-end onshore/offshore claims operations, rebuilt and realigned department structure for better turnaround time, and delivered daily executive briefings to senior leadership across Claims, Configuration, Clinical, IT, Enrollment, and Encounter Management. I’ve also led claims, appeals, grievances, and pharmacy operations—managing large teams and budgets (including $4M operations budget and “2.3M+ claims/month”) while partnering across IT Operations, Configuration, QA, PDM, UM, FWA, and vendor ecosystems to improve cycle time, accuracy, and regulatory outcomes.

Experience

Work history, roles, and key accomplishments

Associate Director, BPaaS

UST

Dec 2021 - Oct 2025 (3 years 10 months)

Directed end-to-end onshore/offshore BPaaS claims operations for a Pennsylvania Medicare health plan, overseeing claims, configuration, QA, IT, PDM, clinical, and encounter management workstreams. Rebuilt department structure to improve turnaround time and compliance with PA contract requirements and CMS mandates, serving as client executive liaison and leading SLA/KPI performance and capacity pla

Medicare BPaaS Capacity Planning

Claims Operations Manager

American Postal Workers Union Health Plan

Aug 2019 - Dec 2021 (2 years 4 months)

Managed 5 non-union supervisors and 65 union staff across claims processing, enrollment, provider file, data entry, mail sort, and scanning while maintaining QA, turnaround, and productivity standards. Owned unit workflow and inventory management, managed the claims operations budget, maintained vendor relationships, and implemented process improvements to reduce cycle time and increase accuracy.

Claims Processing Enrollment Operations Team Leadership Inventory Management Vendor Management

Director of Claims Operations

Trusted Health Plan

Feb 2019 - Jul 2019 (5 months)

Led claims processing, appeals, grievances, and reconsiderations, with direct reports responsible for staff development, training, and retention. Managed provider reimbursement for home health nursing, DME, sleep services, and infusion therapy, conducted vendor audits with error-trend correction, and facilitated CMS-timed appeals/grievance responses.

Claims Adjudication Appeals & Grievances Error Trend Analysis Workflow Root Cause Correction

Pharmacy Operations Program Manager II

Cigna HealthSpring

Jun 2016 - Feb 2019 (2 years 8 months)

Led multisite and remote pharmacy technical analyst teams, managing Medicare Advantage benefit setup/changes, benefits database management, and formulary updates. Served as primary liaison for OptumRx to ensure end-to-end pharmacy claims adjudication compliance, managed CMS-guideline grievances and CTMs, and drove process improvements and contingency planning to meet quality and regulatory metrics

Pharmacy Claim Adjudication Medicare Advantage Formulary Management OptumRx Vendor Oversight Database Management Process Improvement Contingency Plan

Medicare/Medicaid Ops Manager

Cigna HealthSpring

May 2012 - Jun 2016 (4 years 1 month)

Managed a 35-person Medicare/Medicaid department across multiple states, overseeing benefit adjudication configuration, fee schedule loading, provider pricing discrepancy resolution, and aged-claims root-cause analysis. Executed four large-scale market implementations (Illinois MMAI, Illinois ICP, STAR+PLUS NE expansion, SNF expansion) on schedule and in full compliance.

Medicare Medicaid Operations Benefits Configuration Pricing Discrepancies Market Implementation Delivery Multi State Program Support

BlueCard Operations Manager II

CareFirst BlueCross BlueShield

Jan 2008 - Nov 2011 (3 years 10 months)

Managed BlueCard operations with 5 direct and 50 indirect reports, processing 2.3M+ claims per month at a 90% first-pass rate and resolving 20,000+ member/provider/account inquiries monthly. Oversaw a $4M operational budget and restored normal inventory levels within 4 weeks after a system change caused a near-100% inventory spike, with zero added headcount.

BlueCard Operations First Pass Rate Optimization Performance Management Team Management

Program Supervisor (Caremark)

The R ACOM (Caremark)

Nov 2006 - Dec 2007 (1 year 1 month)

Supervised 19 staff across pharmaceutical programs generating up to $6M per year each. Managed 600+ daily cases through personal follow-up, quality monitoring, and cross-team coordination.

Staff Supervision Case Management Team Coordination Budget Oversight

COB & Account Management Manager

MAMSI (UnitedHealthcare)

Mar 1992 - Apr 2005 (13 years 1 month)

Advanced from claims processor to COB manager, overseeing outbound COB operations with 4 supervisors and 32–48 reps, ensuring mainframe compliance and recovery system execution. Directed Alliance PPO claims operations with 44 staff, analyzed claims data for staffing and system decisions, and supported key account relationships as Director of Account Management.

Outbound Recovery Operations Account Management Alliance PPO Claims Staff Supervision