Kelly J. Tan
El Dorado Hills,USA
Summary
Seasoned healthcare professional with over 20 years of experience spanning business process analysis, claims operations, and system administration. Since 2004, consistently recognized for driving operational excellence, regulatory compliance, and cross-functional collaboration in complex payer environments.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Business Process Analyst, Consultant
Blue Shield of California
07.2021 - Current
- Responsible for strategic and transformational implementations across all Commercial and Government lines of business including Medicare, Medi Cal, Small and Large employer group, Individual and Family plans.
- Maintained strong working knowledge of ERP, CRM and business intelligence tools and operational features for 1800+ phone agent end users
- Collaborated with upper management to drive quality and audit standards for all broker, provider and member customer care teams.
- Facilitated annual and open enrollment training for call center agents, covering seasonal updates, portfolio changes, and program revisions across all lines of business.
Project Manager, System Administration
Centene Corporation
05.2018 - 12.2021
- Directed weekly Program Metric Review meeting, created Executive Summaries and provided follow-up on outstanding requests
- Managed overall contract reconciliation effort to recover $500B in claim payments and reduce financial exposure
- Managed contractor team of 20 for all lines of business; coordinating work effort based on Government contract deadlines
- Provided and supported implementation of business solutions by identifying business needs and carrying out necessary practices and processes.
- Identified areas of possible system improvement to enhance overall business performance, accounting for budgetary concerns and business goals.
- Utilized change management techniques to provide smooth transitions during new hardware and software introductions.
Senior Systems Analyst - Claims Adminstration
Health Net Federal Services
12.2015 - 05.2018
- Administered and configured Quantum Choice (QC) to support end-to-end claims adjudication, eligibility verification, and provider data management for a multi-state federal healthcare payer, ensuring compliance with regulatory standards and operational efficiency.
- Collaborated with cross-functional teams to optimize QC workflows, reducing claims adjudication time by 30% through rule-based automation
- Led system upgrades and patch deployments across QC environments, ensuring zero downtime and full compliance with HIPAA, CMS, and VA Federal guidelines
- Defined system solutions and timelines for business needs and technical problems for 1500 provider relations, enrollment and claims end users
- Identified cost-effective improvements to system configuration components for designated upgrades cycles.
Claims, Operations Lead
Health Net Federal Services
02.2014 - 12.2015
- Led the implementation of Claims Operations for VA Patient Centered Community Care (PCCC) program and VA Choice Program
- Responsible for processing $1B in claims payments annually
- Responsible for compliance of Service Organization Control (SOC) 1 audit. and CMS claim processing standards
- Conducted organization - wide training to meet all CMS claim processing standards including timely filing, standardized claim forms , electronic submissions and provider identification guidelines
Provider Services, Operations Lead
Health Net of California
06.2009 - 02.2014
- Lead and developed a team of 28 provider service phone agents
- Managed quality goals, escalations, time keeping and customer service standards
- Reduced overall team handle time by 15% through focused audits and training
- Reduced average hold time by 73% with dedicated one-on-one chairside and role play training
- Collaborated with quality team to develop meaningful training materials relevant to our job scope
Education
Certificate - Project Management
Folsom Lake College
Folsom, CA05-2026
High School Diploma -
Center High School
North Highlands, CA06.1992
Skills
- Requirements gathering
- Technical Writing
- Operations Management
- Facilitation/Project Management
- User acceptance testing
- Quality reporting
- Process change management
- Systems analysis
- Data migration
- Transactions reconciliation
- Regulatory compliance
- Payments posting
Certification
- Project Management Certificate- May 2026
- Six Sigma Yellow Belt SSGI - September 2025
- CBAP, International Institute of Business Analysis - June 2019
Timeline
Business Process Analyst, Consultant
Blue Shield of California
07.2021 - Current
Project Manager, System Administration
Centene Corporation
05.2018 - 12.2021
Senior Systems Analyst - Claims Adminstration
Health Net Federal Services
12.2015 - 05.2018
Claims, Operations Lead
Health Net Federal Services
02.2014 - 12.2015
Provider Services, Operations Lead
Health Net of California
06.2009 - 02.2014
Certificate - Project Management
Folsom Lake College
High School Diploma -
Center High School