Alvin Kuo

• Operated as Business SME and incepted and deployed full end to end automations for team
• RPA1 had 3.36 FTE Save with realized savings of $224,555 annualized
• RPA2 had 3.59 FTE Save with realized savings of $180,352 annualized
• Deployed 3rd partial automation (Interactive SOP UI) which improved quality and efficiency with also had 1.56 FTE Save and realized savings of $78,594 annualized
• Operated as Business SME during key core platform migrations
• Improved infrastructure reporting and deployed advanced analytical tools using BI to improve business outcomes and help data driven solutions
• Provided number of remediation on core systems/contract conflicts that saved business +$500k in soft savings

• Point of Contact/Lead of Sutter operations within Capitated Delegated Issue Resolution
• 2020 accomplishment of saving UHC HMO Claims Operations $5M by root causing number of pain points - Contract language DOFR conflicts between UHC/Sutter
• 2021 Project of creating RPA due to absorption of work flow from separate internal team (6 FTE savings)HMO & Risk Capitation Ops •Point of Contact/Lead of Sutter operations within Capitated Delegated Issue Resolution
• 2020 accomplishment of saving UHC HMO Claims Operations $5M by root causing number of pain points - Contract language DOFR conflicts between UHC/Sutter
• 2021 Project of creating RPA due to absorption of work flow from separate internal team (3 FTE savings)

HMO & Risk Capitation Ops

• Promoted within 12 month probationary period due to exemplary efficiency and process enhancements
• Resolution of more complex risk dispute cases
• Root cause analysis of issues and process enhancement
• Monitoring and follow up with the Delegated Entities to ensure appropriate processing of claims determined to be their responsibility and submission of related encounter data. Monitoring and follow up with the Delegated Entities to collect member data to support resolution of the member cost share issues
• Monitoring and follow up with the Delegated Entities to ensure appropriate re-processing of claims requiring cost share adjustment and submission of related encounter data
• Provided onsite training
• Conducted analysis to address claims leakage issues which led to improved financial outcomes/savings

• Validate, research, and analyze claims payment problems and trends referred by Health Plan, bringing claim issues to resolution
• Coordinate designated claim processing adjustment activities and provide non-adjusted claims follow-up, ensuring closure with provider, member and / or health plan
• Ensure complete and appropriate documentation for all requested claim adjustments
• Processed and audited medical claims in bills total amounting over +$10M dollars
• Assigned Sutter Medical Group after 6 months
• Streamlined entire Sutter process within 2 months to improve claims processing
• Managed/created department SharePoint functionalities

• Contacted Patients, RPh, and MD offices to resolve Claims issues
• Resolved customer issues; ensuring accurate information is provided
• Consistently exceeded established productivity metrics, schedule adherence, and quality (Top Performer)
• Contacted Doctor's offices to obtain information necessary to determine if the Drug Claim is covered under the member's pharmacy benefits
• Outreached to obtain additional information necessary for the Pharmacist or Medical Director to render a coverage decision

• Processing and handling up to 250+ scripts daily
• Continued managing work flow inventory

• Received raise after 90-day probationary period by demonstrating exemplary efficiency and accuracy.
• Managed entire Pharmacy work flow inventory (bottles, labels, etc.)