Open to opportunities

Tracey B

@traceyb

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Claims operations supervisor who improves claim processing quality, leads teams, and mentors new hires at Aetna/CVS.

United States

Message

What I'm looking for

I’m looking for a leadership role where I can run claims operations with strong quality standards, use audits and dashboards to drive improvements, and mentor teams. I thrive in environments that value process clarity, customer/provider focus, and continuous training.

I’m a claims operations supervisor at Aetna/CVS with a long track record in managing complex claim workflows, improving inventory and processing, and driving consistent performance for national and specialized accounts. I’ve managed teams of 20+ claim processors and quality analysts, and I’ve led initiatives that strengthen both accuracy and throughput.

I focus on operational excellence: I manage claim inventory and onboarding processes, developed mentoring for new hires, and created work-from-home transition steps that were adopted by my team. I also build clear action plans from audit results to address gaps in claim processing, and I deliver weekly PG reports to PSL and Account Managers.

Across quality and call operations, I’ve supervised teams responsible for Medicaid and Medicare claim quality, call quality reviews, and initiatives related to CMS tracking and trending. I’ve introduced new quality programs like “PACE,” coordinated unclear item resolution processes, and interviewed and hired applicants to scale and strengthen my teams.

Experience

Work history, roles, and key accomplishments

Current

Supervisor Claim Ops - National

Current

Aetna Insurance / CVS

Dec 2019 - Present (6 years 6 months)

Managed 20+ claim processors, maintained claim inventory using SIM, and developed mentoring and work-from-home transition processes adopted by the team. Produced weekly PG reports and led action plans to address HCA audit results for claim processing teams.

SIM Healthcare Claims Processing Mentoring Audit Remediation

Supervisor Claim Ops - SCSU

Aetna Insurance / CVS

Jun 2017 - Dec 2019 (2 years 6 months)

Led a specialized claims operations team handling infertility and transplant claims, triage, and travel/lodging issues, including repricing for TPA partners using Aetna IOE agreements. Interviewed and hired applicants, rolled out the Aetna Business System, and partnered with HR on job reviews for 4 team members to align to appropriate roles.

IOE Agreements Transplants Infertility Claims GEBAR ACAS TPA Repricing Aetna Business System

Supervisor Call Quality

Aetna Insurance / CVS

Jun 2012 - Dec 2017 (5 years 6 months)

Supervised call quality reviews across multiple lines including Provider Services, Group Life, Medicaid, SCSU/Transplant, and Provider Credentialing. Introduced the PACE quality program using customer surveys and maintained recurring quality meetings to standardize evaluations for frontline staff.

Call Quality Review Provider Services Medicaid Quality Survey PACE Programs

Supervisor Medicaid Claim Quality

Aetna Insurance / CVS

Jan 2015 - Jan 2017 (2 years)

Managed a team of 14 quality analysts by importing claims into QRA to ensure high-dollar reviews on claim check run days. Maintained QA mailbox workflows and exception/unclear logs, and delivered monthly dashboard reporting to business partners to drive timely resolution.

Dashboards Exception Unclear Log Tracking Team Leadership Coventry System Workflows