CLAUDIA SCHWANKER
Stockton,CA
Summary
10+ years of providing on the job leadership and training, instructional learning, and member relations experience. 2+ years of direct people management. Dependable and professional individual who can provide appropriate feedback, efficient ideas, and encouragement to a team and peers. Problem solver committed to growing at Kaiser Permanente with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
11
11
years of professional experience
Work History
Complex Case Unit, Lead Senior Consultant / Interim Executive Escalation Liaison
Kaiser Permanente
Pleasanton, CA
11.2020 - Current
- Assisted physicians, hospital executives and administrators in responding to member complaints, issues and requests
- Ensured the processing of member cases meet federal and state regulatory and accreditation compliance standards and guidelines, as well as internal organizational standards and compliance directives to prepare for audit reviews and to minimize potential financial risks to the organization
- Ability to draft and revise documents
- In-depth knowledge of compliance principles, theories, concepts, health care industry practices, and standards
- Lead and mentored team members with case processing questions and escalations.
Member Relations, Lead Senior Case Manager – Team Subject Matter Expert
Kaiser Permanente
Pleasanton, CA
05.2018 - 11.2020
- Trained peers on how to complete case summaries, add cases for Decision Making Committee reviews, assisted in case processing and created documents on these workflows that were shared statewide
- Led meeting teaching workflows and answering questions
- Participated and facilitated departmental meetings and huddles
- Acted as patient advocate resolving patient care issues
- Answered questions for members and advocates on existing, open, and past cases
- Ability to handle complex issues independently and escalate when appropriate
- Assisted members and advocates with timely review, investigation, and resolution related to their grievance and/or appeals.
Member Relations, Case Manager
Kaiser Permanente
Pleasanton, CA
10.2016 - 05.2018
- Assisted in training and mentoring new employees of the Medicare Grievance team
- Managed a high-volume workload and cases with strict deadlines
- Continually up to date with changes made to the Department’s literature, policies, and desktop procedures
- Facilitated investigation requests for grievances, complaints, and requests
- Coordinated or approved payment waivers and refunds
- Worked closely and had good working relationships with Physicians, Managers, Department Administrators, Local Member Services, Patient Financial Services, the California Service Center, and outside contracted providers to assist with resolution to a member's grievance.
Large Group – Lead Member Processor
Blue Shield of California
Lodi, CA
02.2016 - 10.2016
- Trained and mentored New Hire Processors with member processing questions
- Assisted with Productions Services Inter Site Wide Recognition program (El Dorado Hills, Redding, and Lodi)
- Assisted our department in preparing, planning and engaging in activities, luncheons, and gatherings
- Assigned inventory that needed to be worked via spreadsheets to members on the team
- Accounted and responded when the work assigned was complete
- Handled Escalated Access to Care phone calls for CalPERS, CCPOA and UC members
- Resolved the cases immediately for the members while on the phone with the representatives
- Responded to and resolved, Access to Care Emails, and phone calls from Account Managers, within the set service level agreement goal of 4-hour turnaround time
- Scheduled and facilitated virtual and in person meetings with interdepartmental stakeholders for documentation updates that needed to be made
- Updated and submitted Documentation requests and tasks.
Large Group – Lead Group Processor
Blue Shield of California
El Dorado Hills, CA
04.2014 - 02.2016
- Scheduled and led virtual meetings to ensure that projects were completed by the expected due date
- Updated Employee Desk Level Policies and documents on an ongoing basis to ensure they were correct and in line with management expectations, laws and industry practices that had been passed
- Held meetings to ensure understanding of changes and answered questions that were raised
- Trained employees on the large group team installations, multiple error reports and department procedures
- Created the Quality First Program, which was made to give employees an incentive to meet their set quality goals within their department and to also be recognized for their achievements
- Created and tracked daily reports of errors and resolved the errors at hand
- Issues were escalated as needed
- Submitted tickets for products requests, system enhancements, access requests, facility or performance issues needed to be resolved
- Monitored schedules and creatively managed workflow to prioritize workload to ensure Access to Care goals were consistently met
- Connected with the appropriate departments needed to initiate and submit group and member change requests
- Participated in panel interviewing for prospective employees
- Determined the appropriate staff mix for the department and developed processes to screen, interview, hire, train, and maintain the competency of all department staff
- Provided ongoing staff development.
Interim Lead Auditor
Blue Shield of California
El Dorado Hills, CA
09.2014 - 01.2015
- Verified corrective actions related to audits within the two-day turnaround time mark
- Cross trained employees on several lines of businesses and workflows to support business needs
- Audited all critical data that would create any impact to the member
- Ability to find Member Touchpoint Measures (MTM), Business Critical (BC), and Access to Care (ATC) errors while meeting a 99% accuracy goal
- When finding errors, documented observations with a detailed description of the error and referenced policies to support the error tracked
- Cooperated with the product team to document and communicate reported bugs and feature requests, leading to timely product improvements.
Dedicated Concierge Customer Service Representative – Team Lead
Blue Shield of California
Lodi, CA
11.2012 - 04.2014
- Led and trained a team of 15 newly hired customer service representatives with training policies and guides set by Management
- Provided guidance and mentorship to ensure consistently exceptional customer support
- Provided frontline customer support resolving an average of 40 inquiries a day via telephone or e-mail
- Collected customer feedback, identified and provided process improvements within the team to exceed customer satisfaction goals.
Skills
- 10 years of providing on the job leadership and training, instructional learning, and member relations experience
- 2 years of direct people management
- Strong leadership skills
- Dependable and professional individual
- Project Management
- Teamwork mindset
- Encouragement
- Issue and complaint resolution
- Upbeat and positive personality
- Communication
- Problem solver
References
- Danielle McGrath – Senior Technical Writer – Kaiser Permanente
- Richard Panarello – Learning Consultant – Kaiser Permanente
- Robert Perrin – Director – Kaiser Permanente
- Benjamin Wilgus – Regulatory Consultant - Kaiser Permanente
- Carol Hinds – Regulatory Consultant – Kaiser Permanente
- Michelle Le – Manager – Kaiser Permanente
- Dino De Vera – Senior Consultant – Kaiser Permanente
- Francisco Calero – Senior Case Manager – Kaiser Permanente
- Jonece Liggins – Senior Manager – Lively Inc.
Timeline
Complex Case Unit, Lead Senior Consultant / Interim Executive Escalation Liaison
Kaiser Permanente
11.2020 - Current
Member Relations, Lead Senior Case Manager – Team Subject Matter Expert
Kaiser Permanente
05.2018 - 11.2020
Member Relations, Case Manager
Kaiser Permanente
10.2016 - 05.2018
Large Group – Lead Member Processor
Blue Shield of California
02.2016 - 10.2016
Interim Lead Auditor
Blue Shield of California
09.2014 - 01.2015
Large Group – Lead Group Processor
Blue Shield of California
04.2014 - 02.2016
Dedicated Concierge Customer Service Representative – Team Lead
Blue Shield of California
11.2012 - 04.2014
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