Justin Olesen
Salt Lake City,UT
Summary
Medicaid claims manager with extensive experience in claims processing and compliance at the State of Utah Department of Health. Demonstrated expertise in data analysis and process improvement, leading to enhanced operational efficiency. Skilled in team supervision and training, fostering a collaborative environment that elevates service delivery.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Medicaid Claims Manager
State of Utah Department of Health
Salt Lake City, UT
01.2025 - Current
- Oversaw claims processing for health services in state programs, ensuring compliance with regulations.
- Coordinated with healthcare providers to resolve claim disputes, enhancing resolution rates.
- Provided guidance on complex claims issues to staff and stakeholders, facilitating effective solutions.
- Implemented new claims management software, streamlining workflows and ensuring accurate processing.
- Developed training materials on claims procedures, enhancing staff knowledge and efficiency.
- Analyzed data from previous claims to identify trends, informing operational improvements.
- Led meetings to discuss policy updates and process improvements, driving team alignment.
HEALTH PROGRAM MANAGER I
UTAH DEPARTMENT OF HEALTH
08.2023 - Current
- Ensured compliance with state and federal health regulations within programs.
- Implemented process improvements to streamline workflows, resulting in more effective program delivery.
- Managed recruitment, hiring, training, and mentoring of staff for optimal performance.
- Conducted monthly and quarterly performance evaluations, fostering employee growth and aligning development goals with organizational objectives.
- Developed training materials to support employee development initiatives, equipping staff with essential skills and knowledge.
- Directed and supervised team of 7 employees in daily operations to ensure high productivity.
- Facilitated weekly team meetings to discuss project status and gather feedback.
- Provided guidance on job duties, ensuring adherence to operational standards.
BUSINESS ANALYST
UTAH DEPARTMENT OF HEALTH
08.2021 - 08.2023
- Served as business analyst on project team, supporting development of emergency-only program.
- Defined project requirements alongside stakeholders to ensure alignment.
- Analyzed health data to identify trends influencing policy decisions.
- Collaborated with team to complete backlog for Prism go-live launch, ensuring timely project execution.
- Tested new systems and developed training materials for employee onboarding.
- Streamlined processes through collaboration, enhancing service delivery efficiency.
- Promoted to Claims Examiner II in January 2022, enhancing operational efficiency.
- Assisted customers by addressing inquiries regarding Medicaid coverage.
CLAIMS EXAMINER II
TRISTAR INSURANCE GROUP
07.2012 - 01.2021
- Investigated and analyzed liability for medical damages, ensuring accurate assessments for claimants.
- Reviewed claims for validity and ensured compliance with applicable regulations.
- Evaluated settlement offers to ensure fair compensation for injured workers.
- Corresponded with medical providers and witnesses to gather comprehensive information for workers' compensation claims.
- Communicated effectively with claimants to explain processes and address concerns.
- Managed claim files by documenting all communications and updates accurately.
- Collaborated with legal teams to resolve disputes efficiently regarding claims.
- Conducted periodic audits to ensure compliance with statutory requirements.
Education
HIGH SCHOOL DIPLOMA -
GRANITE HIGH SCHOOL
Salt Lake City, UT06-1998
Skills
- Claims processing and management
- Insurance regulations compliance
- Healthcare regulations knowledge
- Claims investigation
- Data analysis expertise
- Business intelligence analysis
- Process improvement initiatives
- Task delegation and trust-building
- Team supervision and motivation
- Performance assessment and monitoring
- Training and development
- Call center operations management
- Effective communication skills
- Written communication proficiency
- Active listening abilities
- Expectation management
- Creative problem-solving
- Analytical decision-making
- Conflict resolution strategies
- Time management skills
- Procedure implementation skills
- MS Office Suite proficiency
- Remote video conferencing expertise
- Staff recruitment and selection
- Team collaboration
- Relationship management
Certification
SOUL Certificate - State Of Utah Leadership program certificate
Timeline
Medicaid Claims Manager
State of Utah Department of Health
01.2025 - Current
HEALTH PROGRAM MANAGER I
UTAH DEPARTMENT OF HEALTH
08.2023 - Current
BUSINESS ANALYST
UTAH DEPARTMENT OF HEALTH
08.2021 - 08.2023
CLAIMS EXAMINER II
TRISTAR INSURANCE GROUP
07.2012 - 01.2021
HIGH SCHOOL DIPLOMA -
GRANITE HIGH SCHOOL