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Network Power<100 people
Roles
💸40%
Marketing
✨40%
Business Owner
👍40%
Sales & BizDev
Geos
🇬🇧20%
United Kingdom
Work Background
Wilmington UniversityAdjunct Associate Professor
Jun. 2024Human Resources and Business Analytics programs.
Wilmington UniversityAdjunct Assistant Professor
Apr. 2021 - Jun. 2024Human Resources and Business Analytics programs.
MetLifeSr. Quality Analyst II
May. 2017 - Mar. 2025• Acted as liaison between Compliance and MetLife Worldwide Benefits, overseeing complex control initiatives by developing, implementing, and following up on corrective and proactive action plans.
• Verified that action plans were implemented properly and timely.
• Acted as a control champion within the business by supporting management in setting the tone for promoting good business practices.
•Developed and maintained a quality program within the Client Administration Team to ensure accurate delivery of the eligibility, billing, and premium processes; increased accuracy percentage by 23%.
•Delivered monthly performance results to senior leadership regarding the quality program and key initiatives.
•Identified and resolved a key issue that resulted in saving the business approximately $2M in penalties.
•Clearly documented new policies and procedures and communicated these updates to appropriate business partners.
•Supported Global quality initiative for claims, including auditing international claims, reviewing error trending for possible training opportunities, and reporting metrics.
•Trained appropriate third-party administrators and departments on new and updated policies, procedures, systems, etc.
•Assisted in setting metrics to monitor and measure process performance to ensure customers received an exceptional service experience.
•Provided support and expertise in the preparation and submission of RFP responses, ensuring compliance with all requirements and deadlines.
•Collaborated with cross-functional teams to gather necessary information and develop comprehensive proposals that aligned with client specifications.
Wilmington UniversityAdjunct Instructor
Mar. 2017 - Apr. 2021Human Resources and Business Analytics programs.
CignaQuality Review/Audit Senior Specialist - Process Analytics
Oct. 2015 - May. 2017• Managed a team of five to improve error rates and savings
• Leveraged results from other quality areas to identify pre-disbursement review opportunities
• Partnered with Risk Management to utilize performance analytics to enhance the effectiveness of audit programs, improve error rates, and increase savings
• Communicated performance results to business partners in the form of Return on Investment (ROI) and financial impact to senior leadership
Back to Basics Learning Dynamics & Back to Basics K-12 1-on-1 Private SchoolTutor and Interpreter
Oct. 2014 - Dec. 2015
CignaQuality Review/Audit Specialist
Feb. 2013 - Oct. 2015• Led the Cost Containment unit through research and analysis of claims data to determine patterns and abnormalities for at-risk claim activity.
• Trained employees around new policies and procedures
• Created curriculum for onboarding team members, as well as for onboarding Claims and Customer Service Analysts
• Outreached health care professionals to verify services. On daily basis utilized language line services to communicate with Cigna customers, Healthcare Professionals, and other involved parties.
• Worked independently on negotiating pricing and established contracts with health care professionals in an effort to decrease costs for the business
• Managed service inquiries from clients and customers; promoted cost savings measures, including identifying fraud, waste and abuse; average annual savings of $840K annually
• Developed and effectively presented service solutions to entities both within and outside the business
• Identified and engaged with implementing solutions for improvement opportunities to drive process effectiveness and efficiency
• Recovered $620K in overpayment recovery initiative in one year period
CignaService Optimization Team – Service Partner
Sep. 2011 - Feb. 2013• Conducted in depth reviews, processed simple and complex adjustments, answered technical claims and customer service questions, and responsible for staying abreast of changes affecting service centers. • Received phone calls, email, fax, and internet inquiries, of moderate complexity directly from clients and brokers, that were to be acknowledged within 24 hours and resolved with an average TAT of 48 hours. • Logged all incoming inquiries in CMS system for monitoring and tracking. • Assisted the Call Center during peak periods. • Participated in Six Sigma workshop.
• Authorized to approve, release and adjust claims up to $30,000.
• Helped to increase the Net Promoter Score (NPS) score for the business. • Identified root cause analysis and improvement actions within the Contact Center, Eligibility, Claims and Adjustment departments.
CignaService Analyst
Jan. 2011 - Sep. 2011• Responsible for investigating/resolving escalated and complex customer service issues/calls/complaints obtaining necessary information from policies, procedures, or practices. • Served as primary contact and liaison between one or more major customers, Health Plans, Service Centers, and/or functional areas.
• Determined best methods to resolve problems ensuring customer satisfaction and adherence to company policies. • Provided guidance, training and instruction to lower level representatives.
CignaSenior Benefit Analyst / Claims Processor
Jul. 2008 - Jan. 2011• Examined and processed claims and adjustments and/or handle escalated claim issues. Reviewed, analyzed, investigated, and authorized payment of claims within established guidelines. • Communicated with sales force, members, beneficiaries, medical authorities, attorneys, and other involved parties. • Analyzed international benefits to ensure accurate adjudication of claims.
• Translated foreign claims to English in order to adjudicate claims.
• Handled urgent requests assigned from manager.
• Assisted in the processing of medical, dental and vision claims from multiple lines of business within Cigna.
RBCTrust Accountant
Feb. 2006 - Jul. 2008• Processed trust statements and general operational functions. • Ran monthly and quarterly reports, verified statements, performance results and mutual fund transactions.
• Processed daily account information.
• Performed daily cash reconciliation, check requests, maintained and upheld over 150 outside custody accounts monthly, processed trades for accounts through TD Ameritrade.
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