Ashley Delaney
Kansas City,MO
Summary
Accomplished leader with expertise in claims processing and team leadership at Blue Cross Blue Shield of Kansas City. Excelled in cross-functional collaboration, driving process improvements and ensuring regulatory compliance. Proven track record in developing high-performing teams and fostering a culture of innovation and excellence.
Overview
7
7
years of professional experience
Work History
Manager, Claims Operations
Blue Cross Blue Shield of Kansas City
Kansas City, Missouri
08.2023 - Current
- Lead the newly established SWOT team, focused on resolving high-impact claims escalations, driving root cause analysis, and implementing process improvement.
- Directed strategic initiatives to improve operational efficiency and effectiveness across all lines of business, enabling core claims teams to focus on production and inventory management.
- Collaborated cross-functionally with internal stakeholders, as well as external resources and vendors, to deliver measurable improvements in the provider experience and regulatory compliance.
- Led efforts that enhanced tracking of Special Project adjustments, resulting in reduced rework and unnecessary adjustments.
- Provided ongoing leadership to the Government Programs Claims team, ensuring adherence to CMS regulations and operational success.
- Successfully navigated the team through times of organizational change and low morale, including organizing events to promote team collaboration, and facilitating problem-solving sessions to address team challenges.
- Collaborated with senior leadership and peer managers to develop and execute operational goals aligned with BlueKC Core Values, ensuring department objectives supported enterprise-wide priorities.
Supervisor of Operations
Blue Cross Blue Shield of Kansas City
Kansas City, MO
07.2020 - 08.2023
- Hired and developed an entirely new team; grew to 12 personelle including 9 examiners, a Lead, and 2 Liaisons.
- Cultivated internal and external relationships crucial to securing repid and effective resolutinos. Intermediary between departments to identify, triage, and resolve escalatd issues.
- Documented files and reporting for CMS audits
- Responsible for creating SOPs for Medicare Advantage Program- reviewing medical policies, system edits, and member benefits to achieve timely resolution of claims processing and adjustments.
- Improved and automated Special Project Requests
- Participated in regular collaboration meetings with Customer Service, Pop Health, Provider team, and more to review escalated issues, systems errors, and SOPs, and to improve departmental processes.
Operations Lead
Blue Cross Blue Shield Of Kansas
Kansas City, Missouri
11.2018 - 07.2020
- Selected for the CSRx Launchpad team, which designed and implemented a new FUI for Operations to improve consistency and quality of the overall BlueKC customer service experience.
- Coordinated closely with all Call Center Supervisors and Leads in weekly calibration meetings, to align our goals and strategies in call coaching and Customer Liaison development.
- Selected as a subject matter expert in Operations to discuss department activities, workflows, current performance, and processes with Milliman Consulting.
- Created a Skills Matrix for membership department training and development. This document is a comprehensive list of the standard operating procedures and skillsets necessary for team members.
Education
AA Studies
Maple Woods Community College
Gladstone, MOSkills
- Claims processing
- Regulatory compliance
- Operational strategy
- Team leadership
- Cross-functional collaboration
- Process improvement
Timeline
Manager, Claims Operations
Blue Cross Blue Shield of Kansas City
08.2023 - Current
Supervisor of Operations
Blue Cross Blue Shield of Kansas City
07.2020 - 08.2023
Operations Lead
Blue Cross Blue Shield Of Kansas
11.2018 - 07.2020
AA Studies
Maple Woods Community College
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