Jeffrey Clawson, PMP
Pittsburgh,PA
Summary
Professional Project Management Specialist with experience providing operational services to Medicare Advantage plans. Managed staff, clients, and vendors. Willingness to take on added responsibilities to meet company and team goals.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Project Director, Medicare & SNP Operations
UPMC Health Plan
11.2019 - Current
- Oversee the annual Medicare & SNP benefit implementation and system set-up
- Responsible for the submission of the annual Medicare Advantage application
- Business owner of select Medicare supplemental benefits; liaison between operational teams and supplemental benefit vendors
- My teams are responsible for mandatory CMS documents - provider directory, formulary, and ID cards and completing sales assignments
- Managed new project plans, deadlines, and deliverables in an efficient and timely manner
- Leads team members, conducts one-on-one reviews, and manages staff development
- Identified opportunities for process improvement, implementing changes that led to increased efficiency within the organization
Project Manager, Medicare & SNP Operations
UPMC Health Plan
06.2017 - 11.2019
- Led the annual Medicare & SNP benefit implementation and system set-up
- Business owner of select supplemental benefits
- Managed new project plans within Medicare Operations, deadlines, and deliverables in an efficient and timely manner
- Participated in CMS audits and other external audits and internal reviews as necessary
- Created and maintained special projects within the Medicare Operations team and reports for senior management
- Coordinated with cross-functional teams to resolve project issues and mitigate risks
Manager, Medicare TPA
UPMC Health Plan
06.2015 - 06.2017
- Supported the relationship between third-party vendor and Medicare clients by ongoing meetings and status updates
- Managed new projects plans, deadlines, and deliverables in an efficient and timely manner
- Participated in CMS audits and other external audits and internal reviews
- Managed and motivated employees to be productive and engaged in work
Medicare Coordinator, Medicare TPA
UPMC Health Plan
10.2012 - 06.2015
- Acted as liaison between third-party administrator (TPA) business, clients, and supporting internal departments
- Supported the implementation of three Medicare Advantage plans and the onboarding of 20,000+ members
- Participated in CMS audits and other external audits and internal reviews as necessary
- Created and maintained special projects and reports for senior management
- Developed process flows and supervised the TPA department mailbox and other inquiries
- Led meetings and ongoing calls with TPA and client partners
Team Lead, Medicare Enrollment
UPMC Health Plan
04.2010 - 10.2012
- Reviewed reports and identified trends in Medicare enrollment activity
- Led a team of 15+ staff members, conducted team meetings, and completed one-on-one coaching
- Maintained process flows and contributed to the implementation of new policies and procedures
- Worked with Medicare Sales, Member Services, and Compliance to ensure compliant business practices
- Oversaw staff assignments and assisted team members with questions regarding enrollment processing
- Created departmental trainings and conducted off-site trainings with business vendors
Customer Service Analyst, Medicare Member Services
UPMC Health Plan
07.2006 - 04.2010
- Assisted members with questions regarding benefits and claims, premium billing, providers, and enrollment
- Liaised with covered group contacts and answered enrollment and benefit questions
- Provided support on Sales, Pharmacy, Commercial, and Medicaid lines as needed
- Acted as field representative at member health fairs, flu shot clinics, and benefit and retention meetings
Education
B.A. Journalism with a Minor in English -
Duquesne University
Pittsburgh, PA05.2004
Skills
Benefit Implementation
CMS Guidance
Compliance
Customer Service
Detailed Oriented
Leadership
Project Management
Medicare Advantage
Special Needs Plans
Teamwork
Time Management
Vendor Relations
Certification
- PMP - Project Management Professional
Timeline
Project Director, Medicare & SNP Operations
UPMC Health Plan
11.2019 - Current
Project Manager, Medicare & SNP Operations
UPMC Health Plan
06.2017 - 11.2019
Manager, Medicare TPA
UPMC Health Plan
06.2015 - 06.2017
Medicare Coordinator, Medicare TPA
UPMC Health Plan
10.2012 - 06.2015
Team Lead, Medicare Enrollment
UPMC Health Plan
04.2010 - 10.2012
Customer Service Analyst, Medicare Member Services
UPMC Health Plan
07.2006 - 04.2010
B.A. Journalism with a Minor in English -
Duquesne University