Katja Monique Thompson

• Addressed and resolved member inquiries from vendors, clients, and account management to enhance service quality.
• Managed enrollment processing oversight to identify and address potential issues promptly.
• Managed re-enrollment submissions through ServiceNow to ensure timely confirmations in RxClaim
• Ensured adherence to established policies and procedures among vendors, providing recommendations for necessary updates to maintain compliance.
• Evaluated client reports to ensure data accuracy and identify emerging trends.
• Contributed to team efforts in constructing comprehensive knowledge databases to enhance information accessibility.
• Executed comprehensive systems and program testing to ensure functionality and reliability.
• Conducted thorough reviews of member letters to validate precise data population in alignment with established templates.
• Engaged in conference calls with clients and vendors to support account management objectives and enhance collaboration.
• Oversaw client onboarding processes for new implementations. Contributed strategically to special projects to enhance outcomes. Executed additional responsibilities as designated by management.
• Analyzed call data and delivered recommendations during calibration reviews to enhance call center operational performance.
• Resolved member grievances and Medicare complaints by collaborating with the designated account team to ensure timely and effective outcomes.
• Executed monthly evaluations of grievance reports to guarantee precise routing to designated teams.
• Executed analysis of monthly reconciliation spreadsheets to identify discrepancies between the enrollment vendor and RxClaim records.
• Analyzed vendor performance data to determine potential service-level penalties and credits owed to OptumRx.
• Conducted comprehensive comparisons of Power BI SLA dashboard with vendor EGWP SLA files to ensure compliance with established guidelines.
• Analyzed monthly vendor invoices to verify accuracy and ensure compliance with established service periods.

• Worked alongside the BPQM manager to develop and roll out audit programs, ensuring alignment with organizational standards and objectives.
• Analyzed data and prepared detailed reports for leadership and auditors to ensure compliance and transparency.
• Evaluated root causes and analyzed trends to propose improvements that optimize audit results.
• Advocated for best practices to align team efforts with organizational goals.
• Assisted auditors in delivering high-quality outcomes and formulated standard operating procedures to ensure comprehensive documentation of audit processes.
• Conducted yearly evaluations and quality assurance checks to ensure database accuracy and reliability.
• Directed audit appeal oversight, ensuring comprehensive and impartial reviews for accuracy and integrity in audit processes.
• Conducted comprehensive audits and assessments as a Senior Quality Representative on the BPQM team, ensuring adherence to quality benchmarks.
• Conducted thorough quality audits and evaluated findings to identify trends and rectify errors.
• Provided targeted feedback and coaching to enhance performance of operations team members following evaluation assessments.
• Performed detailed audits of benefit installations, verifying client account setups and implementations managed by COBRA and state continuation teams.

Enrollment/Eligibility Representative (3 yrs)

• Oversaw processing of enrollment forms for members and client group requests involving COBRA and Individual Conversion. Maintained and updated carrier eligibility records to ensure compliance. Resolved member inquiries related to COBRA coverage, effectively managing billing discrepancies and plan adjustments.
• Delivered comprehensive training and onboarding support to enhance temporary employee integration.
• Facilitated clear communication of benefits and claim status information to ensure member and provider satisfaction.