Summary
Overview
Work History
Education
Skills
Special Skills And Qualifications
Timeline
Generic

Elizabeth Skains

Merrill,WI

Summary

Results-oriented Analyst skillful in managing and breaking down large volumes of information. Proactive at heading off issues in operations, workflow and production by uncovering trends affecting business success.

Overview

32
32
years of professional experience

Work History

Sr. Capability Analyst

Optum
01.2022 - 01.2025
  • Medicare Advantage provider roster management
  • Liaise with UHC or other Payors to support Configuration Team inquiries
  • Manage Provider Loading to Facets
  • Using SQL queries for Post 1/1 Weekly Audits and Claim Pend support

Employer Installation Specialist Supervisor

OptumRx
01.2004 - 01.2022
  • Mentor and guide team members in adopting best practices and methodologies in the implementation of pharmacy and client pricing contracts
  • Troubleshoot issues with the ability to analyze data and to present analysis in a format that is relatable to interested parties
  • Problem solve/research issues independently to completion
  • Partner with business and technology partners to elicit, analyze, translate, and document business requirements.
  • Preparing data analysis in the required format including tables, charts and graphs with written summaries, conclusions, and recommendations

Senior Pharmacy Technician

Innoviant
01.1999 - 01.2004
  • Implementation of unique client pharmacy benefit plans including coverage, copay, and pricing configuration
  • New client onboarding and loading to RxClaim system based upon contracts to ensure accurate claim processing
  • Identify solutions to non-standard requests and problems
  • SOP/training documentation preparation and presentation
  • Provide customer service to claimants, providers, and plan holders regarding pharmaceutical benefits

Claim Processor/Customer Service Representative

Wausau Benefits
01.1993 - 01.1999
  • Complete quality reviews of my peers
  • Process claims according to specified Claim Services procedures and standards as well as federal/state mandates, all the time holding exceptional quality and performance statistics
  • Provide superior customer service to claimants, plan holders, providers, and other insurance companies regarding health claims
  • Interpret plan wording and intent in order to make sound claim decisions

Education

High School Diploma -

Tomahawk High School
01.1985

Office Management - undefined

New London School of Business
01.1990

Agricultural Business Management - Animal Science

UW- River Falls
01.1989

General Education - undefined

UW- Marathon Center
01.1986

Skills

  • Analytical thinker
  • Organizational skills
  • Advanced Excel/formula creation/Pivot Tables
  • Power Query for Data Validation
  • Healthcare Provider Roster Management
  • 23 years PBM experience
  • Process enhancement

Special Skills And Qualifications

  • Analytical thinker exceptional project management, organizational and communication skills
  • Advanced Excel User; graphs, pivot tables, formula creation
  • Power Query User; using Power Query for data validation
  • Medicare Advantage Provider Roster Management
  • 23 years PBM experience

Timeline

Sr. Capability Analyst

Optum
01.2022 - 01.2025

Employer Installation Specialist Supervisor

OptumRx
01.2004 - 01.2022

Senior Pharmacy Technician

Innoviant
01.1999 - 01.2004

Claim Processor/Customer Service Representative

Wausau Benefits
01.1993 - 01.1999

Office Management - undefined

New London School of Business

Agricultural Business Management - Animal Science

UW- River Falls

General Education - undefined

UW- Marathon Center

High School Diploma -

Tomahawk High School

Similar Profiles

CREATE PROFILE
Elizabeth Skains
Want your own profile? Create for free at ResumeBuilder.com