Description
Insurance * Managed Corporate and Regulatory Compliance (led to 82% reduction in consumer complaints, reduced appeals 34%, and UM cases were reduced 12%) * Implemented privacy program to minimize risk and ensure confidentially of Protected Health Information (PHI). In two years reduced privacy complaints 66% * Assist in the negotiation of vendor contracts with Operations and Legal (led to 24% reduction of fees) * Implemented Fraud, Waste & Abuse program including Hot line for fraud & privacy complaints. * Ensure Third-Party vendor PBM in Compliance with applicable Federal/State regulations * Conducted Code of Conduct, Ethics, and Privacy training where attendance increased 98 percent * Established and chaired Compliance Committee which reports to the Board of Directors * Ensure compliance with Self-Funded Insurance Plans (ASO) and application of ERISA * Establish Enterprise Risk Management programs to identify risks that could harm the company * Represent the Company before Regulators and respond to queries * Chaired weekly roundtable discussions with staff to review complicated cases * Draft policies and procedures that promote compliance with Federal and State laws Company Sarasota FL 8/11 to 10/14
Accomplishments
Highlights:
Keywords
- Complaints
- ERISA
- Multi-line Insurance
- Fraud, Waste & Abuse
- Policies and Procedures
- Cross Functional Management
- Enterprise Risk Management
- Risk Management
- Consulting
- Compliance
- Privacy, HIPAA, GLBA,
- Ethics and Code of Conduct
- Chair Compliance Committee
- Self Funded Insurance
- Appeals and UM Review
- profit and loss analysis
- metrics and analytics
- Leadership
