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Work Background
CVS HealthSenior Manager Product Owner Clinical Client Operations
Jun. 2017Northbrook, Illinois
CVS HealthClient Operations Advisor
Aug. 2013 - Jun. 2017Northbrook, ILAdjudication Systems Advisor: Charged with leading projects and cross functional teams in an automated production environment. Responsible for culminating a leadership role in a pharmacy benefit management industry to improve operational costs and revenue growth. Reports to Vice President - Center of Excellence • Developed new process for effectively managing accumulation issues that have arisen as a part of the client migration process. Lead manual coding process team to ensuring errors are identified prior to implementation date. • Lead project team to implement over 3000 plans within a 45 day time period. Identified all potential issues, and ensured that workarounds were identified prior to clients plan effective date. • Coordinated client issues by being a high energy problem solver; using my creative mindset to identify potential core issues. • Provided support during client migration process by using strong analytical skills, and effectively resolved defect issues by effectively creating and running SAS and SQL Queries • Provided partnership and support to the entire migration team by being a partnership builder with exceptional service focus on internal and external clients’ needs and expectations
CVS HealthBenefit Relationship Manager
Jan. 2009 - Aug. 2013Northbrook, ILBenefit Relationship Manager: Responsible for leading client benefit changes for specific clients who have had benefit challenges, and service interruptions in the past. Ensure that by proper communication and documentation that their intent was captured per their expectations. Reported to Director – Client Benefits • Manage the implementation of client updates to current or future plan designs based on client intent ;
• Manage client’s expectations and council client based on benefit system capabilities and benefits previously implemented by the client;
• Coordinate and manage benefit changes with internal partners by educating internal partners on system capabilities and how to effectively establish client intent;
• Identify quality related issues surrounding client’s intent and business coding needs; • Interpret and communicate ways to improve quality as it relates to the client’s expectations and internal departments; • Document and manage responsibilities as they relate to migration of client’s from current adjudication platform to new adjudication platform
• Proactively participate and learn new processes and programs as well as provide communication and documentation of changes affecting all clients to my account teams.
CVS HealthAnalytic Consultant
Oct. 2006 - Jan. 2009Northbrook, ILAnalytic Consultant: Responsible for providing analytic support to Mid-Market Employer Accounts and designated National accounts. Responsible for training to Account Management for the automated Sales Tools models. Also was responsible for updating and enhancing the Mandatory Mail/Incentivized Refill Restriction and Co-pay Breakeven automated Sales Tools. Reported to Director – Analytic Consulting Systems. • Provide accurate, credible and timely communication and analyses to account teams and clients;
• Supply useful marketplace information and benefit design benchmarking to clients;
• Uses appropriate data mining and reporting tools and provides reports in a readable and usable format with appropriate levels of detail;
• Acquires and maintains knowledge of Caremark data warehouse, tools, and products; serves as expert resource for these to account teams.
Trustmark CompaniesPharmacy Advisor
Jan. 2005 - Dec. 2006Lake Forest, ILPharmacy Analyst: Responsible for pharmacy vendor maintenance and claim data manipulation and support. Responsible for contract pricing, rebates, plan set up and eligibility. Coordinated internal and external design process for Rxaminer database. (January 2006 to October 2006) • Provide recommendations when there are claim load balancing issues;
• Perform cost benefit and analysis on potential and existing clinical programs;
• Coordinate internal and external auditing of pharmacy benefit manager to review contract pricing, rebates, plan set-up, and eligibility;
• Assisted with design, edits and testing of newly created plan benefits (Rxaminer) database;
• Enhance and continue to develop pharmacy benefit savings.
Trustmark CompaniesProject Manager
Jul. 1995 - Dec. 2005Lake Forest, ILProject Manager (Benefits Division): Responsible for managing and enhancing team responsibilities as a part of the electronic claim adjudication process. Responsible for ensuring that all project requirement were met within project deadlines. (July 1995 -January 2006)
• Business Matter Expert for ERISCO ClaimFacts and GroupFacts platforms, Expert System and CORE platforms;
• Responsible for leading Benefits Division projects and direct liaison between Trustmark’s Business Divisions and Trustmark’s IT department;
• Provide business analysis for Benefit division enhancements as well as technical support to the 12 COBOL/Java/AION programmers by creating documentation in the form of project plans and cost analysis, system requests and business requirements;
• Identifying and providing analysis, documentation and cost benefit for production issues.
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