Brenda L. Hickey
Myrtle Beach,USA
Summary
Experienced professional with a strong background in team leadership and process improvement at Aetna. Skilled in data analysis and performance evaluation, driving efficiency, and improving customer satisfaction. Proficient in staff training and fostering collaborative environments to meet organizational goals. Dedicated to maintaining regulatory compliance and ensuring quality assurance.
Overview
24
24
years of professional experience
Work History
Complaints & Appeals Associate Manager
Aetna, a CVS Health
Hartford, CT
08.2024 - Current
- Managed team performance and ensured adherence to company policies.
- Identified opportunities for process improvements and increased efficiency.
- Reviewed completed work to verify consistency, quality, and conformance.
- Planned and led team meetings to review business results and communicate new and ongoing priorities.
- Reviewed employee performance and provided ongoing feedback and coaching to drive performance improvement.
Customer Service Supervisor
Aetna, a CVS Health
Hartford, CT
09.2022 - 09.2024
- Monitored team performance and provided constructive feedback regularly.
- Monitored customer service performance metrics, such as call response times, resolution rates, and customer satisfaction ratings.
- Collaborated closely with upper management on projects involving new initiatives or improvements within the department.
- Resolved escalated customer issues through collaborative problem-solving techniques.
SENIOR QUALITY ANALYST
Aetna, Medicare Healthy Outcomes
Blue Bell, PA
01.2018 - 09.2022
- Developed new methods for widespread QA resource utilization to audit agents effectively.
- Created and analyzed data for quality improvement, producing monthly reports to identify trends.
- Monitored completed work while providing feedback to enhance team member performance.
- Streamlined processes, boosting efficiency and consistency in support of quality initiatives.
MEDICARE CARE PLANNER
Aetna, Medicare Healthy Outcomes
Blue Bell, PA
11.2013 - 01.2018
- Collected data from designated administrative sources, identifying potential enrollees for clinical specialty programs.
- Maintained accurate documentation to comply with risk management and regulatory requirements.
- Monitored task lists and triaged cases to appropriate RNs for efficient processing.
- Collaborated across teams to manage caseloads effectively and provide critical information to management.
MEDICARE CARE MANAGEMENT ASSOCIATE
Aetna, Inc.
Middletown, CT
03.2009 - 11.2013
- Created case management events for Medicare members to initiate support services.
- Monitored task lists and triaged cases to theappropriate registered nurse.
- Produced weekly reports for upper management review to ensure informed decision-making.
CLAIM BENEFIT SPECIALIST
Aetna, Inc., Health Claim Operations
Middletown, CT
08.2008 - 03.2009
- Review and adjudicate routine claims by claim processing guidelines.
- Achieve superior claim and member service through quality programs and reviews.
- Information retrievals to meet member, plan sponsor, and provider expectations.
CREDENTIALING NETWORK REPRESENTATIVE
Aetna, Inc.
Middletown, CT
05.2005 - 08.2008
- Maintain electronic practitioner files and credentialing documentation in a form that meets or exceeds NCQA (National Committee for Quality Assurance) standards.
- Provide adverse action reports to the medical director and credentialing committee for review and action.
- Initiate and track correspondence to complete re-credentialing files.
DENTAL NETWORK COORDINATOR
Aetna Inc, Dental
Hartford, CT
04.2001 - 09.2003
- Streamlined credentialing workflows to achieve enhanced efficiency and reduced costs.
- Developed comprehensive report production processes for all credentialing requests.
- Trained 10 employees on systems and workflows, ensuring compliance with quality standards.
- Reviewed Security Coordinator workflows to optimize business practices.
Education
BBA - Business Administration
Strayer University
Washington, DC09-2026
Associate of Science - Business Administration
Strayer University
Washington, DC09-2025
High School Diploma -
Naugatuck High School
Naugatuck, CT06.1994
Skills
- Work delegation and project management
- Regulatory compliance
- Process improvement strategies
- Data analysis
- Vendor relationship management
- Performance evaluation
- Team leadership
- Customer service
- Documentation and audit skills
- Training material development
- Performance assessment
- Effective communication
- Business administration
- Customer rapport
- Presentations
- Staff management
- Staff training and development
- Verbal and written communication
- Workload management
- Goal setting
- Conflict resolution
- Policy administration
- Team motivation
- Time management
- Problem-solving
- Employee supervision
- Reporting and documenting
Timeline
Complaints & Appeals Associate Manager
Aetna, a CVS Health
08.2024 - Current
Customer Service Supervisor
Aetna, a CVS Health
09.2022 - 09.2024
SENIOR QUALITY ANALYST
Aetna, Medicare Healthy Outcomes
01.2018 - 09.2022
MEDICARE CARE PLANNER
Aetna, Medicare Healthy Outcomes
11.2013 - 01.2018
MEDICARE CARE MANAGEMENT ASSOCIATE
Aetna, Inc.
03.2009 - 11.2013
CLAIM BENEFIT SPECIALIST
Aetna, Inc., Health Claim Operations
08.2008 - 03.2009
CREDENTIALING NETWORK REPRESENTATIVE
Aetna, Inc.
05.2005 - 08.2008
DENTAL NETWORK COORDINATOR
Aetna Inc, Dental
04.2001 - 09.2003
BBA - Business Administration
Strayer University
Associate of Science - Business Administration
Strayer University
High School Diploma -
Naugatuck High School
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