Tauni Bacigalupi
@taunibacigalupi
Senior payment integrity and operations leader driving accuracy, recovery, and scalable process improvements.
United StatesWhat I'm looking for
I’m a Senior Payment Integrity and Operations leader with 10+ years improving accuracy, recovery, and operational performance across Medicaid, Marketplace, and Medicare programs. I build high-performing teams, strengthen vendor partnerships, and deliver measurable financial impact through payment accuracy gains, cost avoidance, and scalable process improvements.
Most recently, I served as Vendor Manager, Payment Integrity (2023–2026), creating comprehensive Quality Audit documentation and overseeing vendor inbound processing, auditing, and data integrity. I improved vendor quality performance by 48% within six months and maintained KPI compliance afterward, while building structured monthly reporting to drive continuous improvement.
Earlier, as Supervisor, Coordination of Benefits (COB), Payment Integrity (2020–2023) and through COB leadership at scale, I ended the first year at 175% of recovery targets and helped stabilize operations by building SOPs, training materials, and repeatable workflows. I partner cross-functionally with IT and Business Analysts to troubleshoot data issues, run SQL-based validations, and automate validation tooling to reduce manual work and increase post-pay recoveries.
Experience
Work history, roles, and key accomplishments
Created comprehensive documentation for Quality Audit processes, vendor processing, and review procedures. Improved vendor quality performance by 48% within six months via a corrective action plan and maintained KPI compliance while auditing vendor inbound files and accuracy.
Built and led a Coordination of Benefits (COB) team of 20+ processors, stabilizing operations and ending the first year at 175% of recovery targets. Streamlined workflows and partnered with developers to automate insurance validation and claims exemption, significantly reducing manual work and tripling post-pay recoveries year over year.
Medicare Appeals Supervisor
UnitedHealthcare, Inc.
Jan 2017 - Jan 2020 (3 years)
Supervised Medicare appeals team operations to meet departmental goals, productivity, and quality standards. Analyzed operational, financial, and quality data to optimize workflows, identify compliance risks, and implement proactive solutions through coaching and performance management.
Appeals Business Process Analyst
UnitedHealthcare, Inc.
Jan 2016 - Jan 2017 (1 year)
Handled complex appeals cases and escalations as a subject matter expert. Identified operational trends and developed solutions to improve accuracy and reduce rework, providing targeted coaching, training, and root-cause feedback.
Senior Claim Appeals Representative
UnitedHealthcare, Inc.
Jan 2015 - Jan 2016 (1 year)
Investigated claim processing to determine denial reasons and completed required Medicare appeal documentation. Communicated appeal outcomes to all parties within mandated timeframes and consistently exceeded established performance and quality standards.
Supervised frontline operations, coached team members to exceed goals, and built strong client relationships to support financial recommendations. Delivered high-quality customer service while identifying financial product opportunities and routinely exceeding sales and service metrics.
Education
Degrees, certifications, and relevant coursework
Long Beach City College
Liberal Studies
2007 - 2008
Completed Liberal Studies coursework at Long Beach City College from 2007 to 2008.
Chaffey College
Education, Teaching Program
1999 - 2002
Studied the Education, Teaching Program at Chaffey College from 1999 to 2002.
Biola University
Secondary Education
1998 - 1999
Completed Secondary Education coursework at Biola University from 1998 to 1999.
Availability
Location
United StatesAuthorized to work in
Job categories
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