Susan Eccles
Littleton,CO
Summary
Results-driven THN Manager bringing proven skills in administering healthcare insurance risk management programs. Effective in training team members to proactively identify and highlight potential risks. Dedicated to long-term risk management by building strong internal protocols and instilling culture of responsibility and attentiveness.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Provider Directory Compliance Manager
Cigna
06.2021 - Current
- Responsible for a team that remediates and or validates provider data from a 3rd party vendor via outbound calls
- Team is responsible for ensuring the accuracy of data updated or already validated in source systems
- Daily reports and monitoring of each state compliance is adhered to
- Responsible to testing new automation tools to ensure accuracy
- Team went from manual spreadsheets barely making a 6 day turn around time to same day turn around time with automation
- Work with external business partners to ensure data accuracy is translated correctly into Cigna systems
- Partner with external vendors to ensure a smooth transition when changing operating systems.
- Improved communication channels between departments by establishing regular meetings and reporting structures related to compliance matters.
- Collaborated with cross-functional teams to establish clear compliance guidelines and expectations for all departments.
Provider Directory Quality Manager
Cigna
08.2019 - 06.2021
- Remote
- Responsibilities included being responsible for all quality and training aspects of the Directory Compliance team
- Team was responsible for end-to-end audits from the 3rd party vendor through the correct updates to online provider directories
- Collaborated with legal partners to ensure the intent of the law was being adhered to
- Managed a team onshore and offshore to ensure quality was being adhered to
- Quality metrics improved from 71% to 95%
- Trended data and identified root causes.
- Streamlined production processes by identifying areas for improvement and implementing corrective actions.
- Provided training to employees on best practices in quality management, fostering a culture of excellence within the organization.
- Led continuous improvement initiatives by actively seeking opportunities for process optimization and cost reduction.
THN Risk Manager
Cigna, Greenwood Village
06.2018 - 08.2019
- Develop Corrective Actions Plans and coordinate with compliance department to ensure activities are monitored and adhered to
- Responsible for intake items and for securing funding of projects
- Track and monitor various LMI activity and analyze risk for compliance activities
- Work on responses for Department of Insurance Complaints or inquiries
- Respond for Request for Inquiries from various legislative areas.
- Managed all US states for risk and compliance
- Reduced compliance risk in certain states by 98% by implementing system changes
DSA Project Manager
Cigna
04.2016 - 05.2018
- Worked on various/ potential DSA's which include product development, Network Adequacy requirements, Medical Management, Delegation, Sales, U/W, Pricing, Customer Service, Billing, and Reporting
- Created implementation plan for Qani platform for Hospital Verticals
- Assisted in developing several SOPs for cross platform work and reporting.
- Managed 6 different DSA with various needs and agreements
- Decreased turn around time from 36 days to 19
Business Readiness Lead
Cigna
11.2008 - 03.2016
- Years 4 months | Greenwood Village
- Business Readiness Lead for Facets platform
- Created templates and tracking tool to ensure BR activities were identified and completed on time
- Led cross functional work groups to determine best practices and made decisions on those items
- Partnered with external business units to ensure deliverables were completed and evaluated prior to go live
- Worked on warranty items after projects went live
- Developed interim manual process until IT enhancements could be put into place
- Worked on large scale, multi -year projects (CDHP, AIMS, IFP, Implementation Re-structuring.
- Reduced case installation from 64 days to 7 days end to end
THH Risk manager
- Responsibilities include Central Intake for items that come from many different business areas within Cigna
- Actively work with outside regulators to respond to various Department of Insurance Inquiries or complaints
- Develop Corrective Action Plans and work with business partners to ensure we are adhering to what was outlined
- Serve as Point of Contact within THN as items come into the pipeline for evaluation
- Worked on several projects including getting an operating model and governance model established for intake items
- Work with business units to identify gaps or process changes needed in order to be compliant with the state / federal regulations.
Education
Master of Business Administration -
Regis University
Denver, CO12.2005
Bachelor of Science - Athletic Training and Biology, Health
North Dakota State University
Fargo, ND05.1993
Skills
- Internal Audits
- Microsoft Excel proficiency
- Data Analysis
- Risk Mitigation
- Risk advisory
- Business process improvement
- Operations Management
- User Acceptance Testing
- Staff Management
- Strategic Planning
- Quality Assurance
- Project Management
- Release planning
- Workflow Analysis
- Data Mapping
- Business Planning
Certification
Six Sigma Certified Blackbelt - June 06
Timeline
Provider Directory Compliance Manager
Cigna
06.2021 - Current
Provider Directory Quality Manager
Cigna
08.2019 - 06.2021
THN Risk Manager
Cigna, Greenwood Village
06.2018 - 08.2019
DSA Project Manager
Cigna
04.2016 - 05.2018
Business Readiness Lead
Cigna
11.2008 - 03.2016
THH Risk manager
Master of Business Administration -
Regis University
Bachelor of Science - Athletic Training and Biology, Health
North Dakota State University
Similar Profiles
Diahanna BridgesDiahanna Bridges
Customer Service Representative at CignaCustomer Service Representative at Cigna
Jennifer SmithJennifer Smith
Eligibility Representative – Specialty Pharmacy Division at CignaEligibility Representative – Specialty Pharmacy Division at Cigna
Rudee FriarRudee Friar
Customer Service Representative at CignaCustomer Service Representative at Cigna
EBONY WILLIAMSEBONY WILLIAMS
Prior Authorization Representative at CignaPrior Authorization Representative at Cigna
Daniel RabhanDaniel Rabhan
Team Lead Inbound Sales - SaaS HR/FinTech at Deel Inc.Team Lead Inbound Sales - SaaS HR/FinTech at Deel Inc.