Brooke Fugate
Milford
Summary
Experienced professional with strong regulatory expertise and documentation skills. Successfully managed compliance monitoring projects, ensuring alignment with industry standards while delivering timely reports to stakeholders and leadership.
Overview
7
7
years of professional experience
Work History
Compliance Consultant
Elevance Health
Mason, OH
09.2024 - Current
- Assisted in conducting investigations to gather relevant information. Documented findings for clarity and future reference. Updated stakeholders and leadership on key developments.
- Participate in compliance monitoring to identify process gaps, validate compliance levels, map processes, draft corrective actions/remediation plans.
- Provide advanced level support to regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments.
- At the advanced level, analyze and extract regulatory data, documentation for compliance with requirements.
- Conducted regular reviews of existing policies and procedures, ensuring continued alignment with evolving industry standards and best practices.
Grievance and Appeals Lead
Elevance Health
Mason, OH
11.2021 - 09.2024
- Monitor work flow and make assignments to ensure the correct team resource is utilized to achieve accreditation and regulatory compliance metrics in a quality manner.
- Coach, train, and audit to ensure the team correctly utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) to its entirety.
- Train new hires. This includes creating the training curriculum, training documents and extensive monitoring of cases.
- Assists management in process improvement strategies to achieve business objectives.
- Review reports and report these findings to our Compliance team and other internal and external entities.
- Developed and maintained relationships with external organizations, to ensure process compliance.
- Mentor analysts by maintaining a team chat of 20 or more analysts. This includes answering questions and assist with complex cases that require extensive research.
Grievance and Appeals Analyst
Elevance Health
Mason, OH
03.2019 - 11.2021
- Review, analyze and process non-complex to complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language. These grievances included Executive Complaints that were received directly with Elevance Health CEO, Gail Boudreaux.
- Served as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments.
- Analyzed and rendered determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination.
Education
Bachelor of Science - Psychology
Wilmington College
WilmingtonBachelor of Science - Applied Behavioral Science
Wright State University
Dayton, OHSkills
- Regulatory expertise
- Documentation skills
- Reporting skills
- Project management
- Compliance
- Documentation review
Timeline
Compliance Consultant
Elevance Health
09.2024 - Current
Grievance and Appeals Lead
Elevance Health
11.2021 - 09.2024
Grievance and Appeals Analyst
Elevance Health
03.2019 - 11.2021
Bachelor of Science - Psychology
Wilmington College
Bachelor of Science - Applied Behavioral Science
Wright State University