Kelly W. Erickson
West Palm Beach,FL
Summary
Over 20 years of experience in Healthcare Payment Integrity with a focus on Transformation and Strategic Initiatives. Proven track record in driving Cross Functional Collaboration and establishing Global Partnerships. Expertise in Product and Program Management, complemented by strong Vendor Relations and a Military background. Successful in executing projects independently and within teams, enhancing overall Employee Experience.
Overview
25
25
years of professional experience
Work History
Director Fraud & Abuse
Optum, UHG
West Palm Beach, Florida
11.2024 - 11.2025
- Staff oversight of 200+ supporting employees and individuals, Medicare and retirement, and community and state lines of business, performing investigations and clinical coding reviews for prepay fraud.
- Coordinated with global partners on KPIs, quality, transformation efforts, training, and expansion of services in Puerto Rico, India, and the Philippines to maximize globalization business goals.
- Created an internal Project Manager role that executed over 45 projects and initiatives.
- Partnered with the Transformation team to drive efficiencies in claims per hour through the integration of a work allocation tool.
- Identified 2 Black Belt projects in Quality and Forecasting, created quality action plans, upskilling plans of action to maximize resources, redefined SIU All Hands meetings, and created new team communications through Employee Action Plans.
Senior Product Manager
Optum Insight, UHG
West Palm Beach, Florida
08.2023 - 11.2024
- Drove product initiatives through a data-driven approach for Facility Audit and Review (FAR), accountable for $350M in revenue.
- Managed the execution of new capability development by creating strategic roadmaps and detailed project plans to drive accountability for on-time delivery.
- Using the Product Management Accelerate Framework and Agile Methodologies, I led capital-funded projects through the Ideate and Define phases. Facility Audit Readmissions - $400K Capital Funding/$5.8M Benefits, and Post Pay IBR - $700K Capital Funding/$3.5M Benefits.
- Facilitated Product Strategy meetings with key stakeholders to align the Voice of the Customer, Business Growth, Market insights, and Industry Standard expectations.
Senior Director/Director of Operations
Equiclaim, Change Healthcare
Lombard, Illinois
06.2017 - 08.2023
- Staff oversight 56, Global Initiatives, Retrospective Chart Review.
- Directed the Lombard office closure, converting 192 staff members to a full remote workforce.
- Project managed the offshoring transition for the post-pay audit and recovery process.
- Redesigned the organization to build out Centers of Excellence.
- Reduced medical record spending by more than $800K through interoperability efforts in 7 months.
- Integrated cost avoidance process for outgoing letters, cumulative savings of $2.5M over 3 years.
- Co-developed four Leadership and Engagement programs.
- Completed over eighty functional excellence outputs.
Manager/Sr. Manager of Operations
Equiclaim, Emdeon
Lombard, Illinois
05.2013 - 06.2017
- Staff oversight, 60, administrative support, and refund recovery processes for payment integrity post-pay audits.
- Mentored and coached the team through routine team meetings, employee one-on-ones, awards and recognition, performance review processes, and individual focus audits when appropriate.
- Integrated Quality Assurance process.
Investigator/Manager of Operations
Trustmark Insurance, SIU
Lake Forest, Illinois
04.2005 - 05.2013
- Oversee Projects Team, Records Retrieval, and Triage for Fraud, Waste, and Abuse audit reviews.
- Assisted in developing an offshore initiative for workflow processes to create efficiencies and cost savings for the business.
- Manage the Operations team and direct reports through routine team meetings, employee one-on-ones, awards and recognition, performance review processes, and individual focus audits when appropriate for a team of 12 employees onshore and 15 offshore.
- Conducted thorough investigations into suspected insurance fraud cases.
Worker's Compensation Investigator
The Hartford
Orlando, Florida
03.2001 - 04.2002
- Determined the severity of workers' compensation claims.
- Conducted on-site accident investigations to inspect equipment for subrogation purposes.
- Covered Southeast and Southwest Florida territories.
Education
Product Management
280 Group Optimal Product Management
Online01-2024
Certificate - Lean Six Sigma Green Belt
Change Healthcare Six Sigma Program
Change Healthcare03-2023
Associate of Science - Criminal Justice
IRCC
Ft. Pierce, FL 05-2000
Personnel Actions Specialist
US Army
Ft. Stewart, GA01-1987
Skills
- Senior leadership
- Change management
- Investigations
- Mentoring and coaching
- Culture engagement
- Operational excellence
- Product management
- Business transformation
- Strategic initiatives
- Vendor negotiations
- Contract management
- Business development
- Client and vendor implementations
- Large-scale project management
- Presentation facilitation
- Quality assurance
- Educational design and development
- Cross-functional collaboration
Affiliations
- Co-Chair Veterans of Change Business Resource Group - 2018/2019
- Culture Ambassador Alumni Coach - 2017/2018/2019
- Culture Ambassador - 2015/2016
- Pinnacle Club Winner - 2015
- Rise Award Recipient - 2014
- Honors Graduate -2000
- Who's Who in American Junior Colleges - 2000
DEI Projects
- Culture Ambassador, United Health Group 2023-2024
- Chairman, Veterans of Change Business Resource Group 2015-2022
- Lead, Payment Integrity Engagement Committee 2018- 2019
- Culture Ambassador, Change Healthcare 2015-2019
Timeline
Director Fraud & Abuse
Optum, UHG
11.2024 - 11.2025
Senior Product Manager
Optum Insight, UHG
08.2023 - 11.2024
Senior Director/Director of Operations
Equiclaim, Change Healthcare
06.2017 - 08.2023
Manager/Sr. Manager of Operations
Equiclaim, Emdeon
05.2013 - 06.2017
Investigator/Manager of Operations
Trustmark Insurance, SIU
04.2005 - 05.2013
Worker's Compensation Investigator
The Hartford
03.2001 - 04.2002
Product Management
280 Group Optimal Product Management
Certificate - Lean Six Sigma Green Belt
Change Healthcare Six Sigma Program
Associate of Science - Criminal Justice
IRCC
Personnel Actions Specialist
US Army