Summary
Overview
Work History
Skills
Timeline
Generic

Karen Chandler

Belews Creek,NC

Summary

Dedicated and self-motivated Operations Manager dedicated to sustaining operational accuracy, production management, and thrive in fast-paced and changing environments. In-depth knowledge of self funded claim administration.

Overview

24
24
years of professional experience

Work History

Operations Manager/Project Business Lead

Medcost
Winston-Salem, NC
01.2019 - 02.2024
  • Managed team of 15 staff members administering 72 employer groups self funded benefit plans for medical, dental and vision
  • Managed team of 2 staff members administering Predeterminations and Adverse Benefit Determination Appeals for 72 employer groups self funded benefit plans
  • Managed scheduling, training and inventory control.
  • Supervised day-to-day workflow of employees in order to maximize productivity and maintain quality standards.
  • Built strong operational teams to meet process and production demands.
  • Monitored and improved efficiency of processes, and team performance.
  • Assessed employee developmental needs, created performance action plans, monitored progress and delivered disciplinary action as necessary.
  • Coordinated with other departments including eligibility, customer service, configuration, quality, reinsurance, etc to ensure efficient operations.
  • Collaborated with management team on long-term strategic planning initiatives for the organization.
  • Analyzed data from daily reports to identify trends in production performance metrics.
  • Analyzed data from weekly and monthly quality reports to identify areas of improvement
  • Defined business requirements, claims-routing and team workflows for new system.
  • Developed and implemented standard operating procedures to ensure quality standard are met and optimize productivity through standardization.
  • Developed key performance indicators to measure effectiveness of operational processes.
  • Support customer service with escalated issues
  • Annual performance reviews

Operations Manager/Supervisor

Medcost
Winston-Salem, NC
05.2008 - 01.2019
  • Managed a team of 35 staff members administering 150 employer groups self funded benefit plans for medical, dental, vision, flex and short-term disability claims.
  • Managed a team of 2 staff members administering Predeterminations and Adverse Benefit Determination Appeals for 150 employer groups self funded benefit plans
  • Managed scheduling, training and inventory control.
  • Supervised day-to-day workflow of employees in order to maximize productivity and maintain quality standards.
  • Monitored and improved efficiency of processes, team performance, and customer service.
  • Assessed employee development needs, created performance action plans, monitored process, provided feedback on their progress and delivered disciplinary action if necessary,
  • Analyzed data from daily reports to identify trends in production performance metrics.
  • Analyzed data from weekly and monthly quality reports to identify areas of improvement.
  • Coordinated with other departments including eligibility, customer service, configuration, quality, reinsurance, etc. to ensure efficient operations.
  • Monitor to ensure defined key performance indicators on target to be met.
  • Conducted regular reviews of existing policies and procedures for continuous improvement opportunities.
  • Collaborated with management team on long term strategic planning initiatives for the organization.
  • Support customer service with escalated issues.
  • Annual performance reviews

Senior Claims Analyst/Team Leader

Medcost
Winston-Salem, NC
04.2002 - 05.2008
  • Followed all company procedures to keep data confidential.
  • Reviewed, researched and evaluated customer claims to determine coverage under policy provisions or applicable laws.
  • Met or exceeded established quality and performance standards as an analyst
  • Established clear expectations for employees, providing guidance when needed.
  • Held weekly team huddles to provide process updates, discuss issues, and brainstorm.
  • Analyzed data from various sources to identify areas of improvement in the department's operations.
  • Collaborated with other departments to ensure alignment of goals across teams.
  • Maintained a positive work environment that promoted collaboration between team members.
  • Participated in regular meetings with senior leadership to provide updates on team progress.
  • Offered training and support to keep team members motivated and working toward objectives.
  • Delegated daily tasks to team members to optimize group productivity.

Senior Commercial Claims Analyst

Qual Choice
Winston-Salem, NC
09.1999 - 04.2002
  • Followed all company procedures to keep data confidential.
  • Reviewed, researched and evaluated customer claims to determine coverage under policy provisions or applicable laws.
  • Met or exceeded established quality and performance standards as an analyst

Skills

  • Operations Management
  • Decision-Making
  • Team Leadership
  • Staff Management
  • Staff Development
  • Performance Evaluations
  • Performance Monitoring
  • Operational Efficiency
  • Cross-Functional Collaboration
  • Data Analysis
  • Quality Assurance and Control
  • Inventory Management
  • Production

Timeline

Operations Manager/Project Business Lead

Medcost
01.2019 - 02.2024

Operations Manager/Supervisor

Medcost
05.2008 - 01.2019

Senior Claims Analyst/Team Leader

Medcost
04.2002 - 05.2008

Senior Commercial Claims Analyst

Qual Choice
09.1999 - 04.2002

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Karen Chandler