Annie M. Kessenich
De Pere,WI
Summary
Analytical and results-driven professional with Fortune 500 experience seeking an exciting opportunity that requires strong relationship building and maintenance skills, an innovative mindset, and a grasp of overall business strategy and operations. Possess strong interpersonal communication skills and adept to collecting and analyzing relevant data, as well as presenting complex strategies and concepts. Eager to learn and determined to achieve meaningful results and positive growth.
Overview
16
16
years of professional experience
Work History
Humana Inc
01.2008 - Current
Senior Process Improvement Professional
03.2019 - Current
- Problem, Incident and Event Management
- Development of internal COVID-19 claim processing tracking and dashboard, ensuring compliance with CMS and DOI requirements
- Ongoing leadership support, including meeting facilitation, process improvement assignment, execution of strategy sessions and conversations as requested by various leaders and directors
- Maintain and provide expertise of contract interpretation, benefit plans, delivery systems, products, policies, and procedures as it relates to claims processing and payment
- Creation and presentation of PowerPoint and training documents specific to job scope, relevant project work, and organizational goals
- Implementation of claims processing automation increasing auto adjudication by 3% from 2020 through current whilst maintaining a financial, payment, and processing accuracy of 99%
- Identification of inefficiencies and process improvement related to member/provider outbound communications
Process Improvement Professional
08.2014 - 03.2019
- Claims System Support and Automation
- Maintain, integrate, and implement software applications and logic within the organization
- Ensure proper controls are established and maintained over test, production, and software source code systems
- Adept in system and claims investigation and defect remediation
- Skilled in trend/reporting identification and communication
- Claim platform configuration
- Utilization of reporting applications for business analytics and project work
Enrollment Professional
10.2012 - 08.2014
- Membership and Plan Services
- Support and resolution of escalated enrollment issues
- Organize monthly collaboration meetings with legal and compliance to ensure accurate implementation of footprint state individual and group benefit and enrollment
- Implementation of state specific enrollment guidelines and communications
- Designed reporting format, leveraging multiple internal database systems, to streamline internal enrollment data used by multiple cross functional teams
Integrated Customer and Provider Specialist
03.2008 - 10.2012
- Consumer Service Operations
- Proficient in priority and specialty employer group claim queues
- Subject matter expert in provider, customer, and claim remediation
- Manage and maintain sourcing of commercial and individual policy integrated deductible project work
- Group and individual accumulation issue resolution including claim rework, exception process implementation, and internal feedback
- Customer service lead experience
- Claims Compliance Charter Team member resulting in an increase of 4.2% accuracy in first pass claim processing from 2010 to 2012
Education
Bachelor of Science - Business Administration, Marketing, Communications
University of Wisconsin - Green Bay
Green Bay, WI12.2005
Skills
- Strategic Business Relationships
- Claims Reporting & Forecasting
- Internal Business Consultation
- Emotional Intelligence
- Conflict Resolution
- Health Plan Operations
- Relational Databases
- Growth Planning
- Collaborate Cross-Functionally
- Employee Coaching and Mentoring
Timeline
Senior Process Improvement Professional
03.2019 - Current
Process Improvement Professional
08.2014 - 03.2019
Enrollment Professional
10.2012 - 08.2014
Integrated Customer and Provider Specialist
03.2008 - 10.2012
Humana Inc
01.2008 - Current
Bachelor of Science - Business Administration, Marketing, Communications
University of Wisconsin - Green Bay