Jesseca Hauser
Appleton,WI
Summary
Seasoned collaborator experienced in meeting needs, improving processes and exceeding requirements in team environments. Diligent worker with strong communication and task prioritization skills.
Overview
14
14
years of professional experience
Work History
Business Analyst III
ThedaCare
07.2024 - Current
- Analyzes the business problem by gathering stakeholder information to specify requirements (technical, data, visual, delivery mechanism) for business solution
- Estimates development effort and related timeline
- Designs, builds, tests, validates, and implements data solutions that deliver actionable insights through visualizations
- Equips key stakeholders and leaders with data and analysis to make informed decisions to improve operational performance
- Educates stakeholders on tool utilization and interpretation of data
- Serves as a subject matter expert in business and data knowledge for respective area
- Forms a business partnership with stakeholders for the purpose of creating shared expectations and maintaining open communication
- Manages scope, tasks, and resources to meet defined timelines
- Escalates issues or barriers when appropriate
- Writes and maintains clear, concise requirement documents, reports, standards, plans, analysis, and specifications including metadata supporting data governance.
Onsite Clinic Account Representative
ThedaCare
04.2023 - 06.2024
- Manages relationships with clients, agents and brokers for their Onsite or Near-site clinics
- Coordinates Onsite clinic with Onsite Wellness for Health Risk Assessments, Physical Therapy, EAP and Pharmacy
- Maintains a high level of customer engagement through thoughtful and purposeful communication
- Produces and reviews utilization reports including ROI, Health Plan Savings and Transparency Pricing data for clients quarterly, semi-annually and annually
- Compiles health plan data from health insurance carriers and onsite clinic data to direct onsite clinic initiatives to manage KPI
- Stakeholder for agile development of Pharmacy/340B Onsite Clinic implementation
- Produces zero dollar claim reporting for full integration into health plan data
- Maintains rosters for onsite clinic eligibility
- Manages initial client implementations, attends employee benefit meetings, manages marketing and customer service issues.
CX/Customer Sucess Consultant (limited Consulting Contract)
Aegis LLC, A Charles Taylor Company
08.2022 - 04.2023
- Reviewed relationships with clients, agents and brokers for Wisconsin County Association-Group Health Trust
- Produced and reviewed utilization reports
- Reviewed initial client implementations, employee benefit meetings, escalated customer service issues for systemic process improvement
- Aligned business model with programmatic systems and processes.
Fraud, Waste and Abuse Investigator
Humana Inc.
01.2020 - 08.2022
- Conducted investigations of allegations of fraudulent and abusive claims practices
- Conducts audits of provider records ensuring appropriateness of billing practices
- Prepares complex investigative and audit reports
- Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
- DOI and other regulatory submissions as related to claims payment and integration
- Grievance and Appeal Claims review and processing
- Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
Account Installation Professional 2 -Senior
Humana Inc.
08.2015 - 01.2020
- Establish a direct relationship with our employer groups/agents that will create a service differentiator unmatched in the industry
- Owning all aspects of account installation for medical, dental, Humana GO365 and vision large group clients
- Manages Humana GO3665 corporate wellness in conjunction with small and large group health plans
- Key stakeholder in agile product development teams for custom benefit solutions
- Claims and benefits escalations: investigating why claims have not paid as expected, claims not reflecting services performed, and reaching out to providers to help obtain resolution
- Work with internal and external partner to ensure timely results for projects and complex escalated issues
- Ensuring custom benefit plan claims payment practices are built and processing correctly
- Submission of custom plan documents to appropriate regulatory agencies
- Ensuring claims payment practices align with plan and paid accurately
- Argus and pharmacy claims payment alignment with custom benefit plans
- Shining Star Award August 2017 and November 2019
- Projects Managed: Dental Primary Care Dentist Assignment Project with over $500,000 in savings in capitated payments to erroneously assigned Primary Care Dentists, Certificate Print Reduction Project with savings of over $1 million in postal mail expenditures.
Account Concierge Specialist, Humana Specialty Benefits
Humana Inc.
08.2010 - 08.2015
- Served as subject matter expert for non-standard coverage questions
- Resolved routine and complex claims issues by performing detailed research to provide root cause
- Managed denials, late payments, extensions and other special circumstances for Large Group and Self-Funded Commercial Clients
- Supported customer care calls for KMG (Long- and Short-Term Disability) and Medicare calls
- Certificate of Excellence in Project Management, Customer Service and Six Sigma Green Belt.
Education
Bachelor of Arts - Education
University of Wisconsin Oshkosh
Oshkosh, WISkills
- Microsoft Office suite (Word, Excel, PowerPoint, SharePoint)
- Power BI, Tableau
- Business process improvement
- Data Mining
- Operational Reporting
- Business Process Mapping
- Competitive Analysis
- Data Analysis
- Customer Needs Assessment
- CRM Systems
Timeline
Business Analyst III
ThedaCare
07.2024 - Current
Onsite Clinic Account Representative
ThedaCare
04.2023 - 06.2024
CX/Customer Sucess Consultant (limited Consulting Contract)
Aegis LLC, A Charles Taylor Company
08.2022 - 04.2023
Fraud, Waste and Abuse Investigator
Humana Inc.
01.2020 - 08.2022
Account Installation Professional 2 -Senior
Humana Inc.
08.2015 - 01.2020
Account Concierge Specialist, Humana Specialty Benefits
Humana Inc.
08.2010 - 08.2015
Bachelor of Arts - Education
University of Wisconsin Oshkosh
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