Kristen Lulich
Summary
Senior Consultant with excellent critical thinking and team-building talents. Familiar with the policies and procedures of product development and operations. Adept in collaborative problem solving, risk management and creative solutions. Passionate about bringing changes in businesses. Proficient in conducting primary and secondary research.
Overview
13
13
years of professional experience
Work History
Senior Consultant & Project Lead, Member Rights and Benefits
HealthPartners
08.2017 - Current
- Pharmacy Project Lead which entails staying up to date on changes, creating and updating internal resources, presenting to departments, consulting on appeal files, and providing work direction to colleagues
- Reporting Project Lead which entails use of Business Objects, Power BI, and Microsoft Excel to provide yearly, quarterly, monthly, and miscellaneous reports presented to leadership
- Prepare and present clinical appeal files to Medical Directors
- Assist with reviewing and preparing audit files which are reviewed by different regulators.
Senior Consultant, Member Rights and Benefits
HealthPartners
2016 - Current
- Investigate and respond to second level appeals
- Provide a summary of the first level appeal to employer groups
- Train new consultants
- Create, update, and maintain internal resources for various topics
- Use Business Objects and Microsoft Excel to provide various reports to department leaders.
Consultant, Member Rights and Benefits
HealthPartners
02.2014 - 03.2016
- Investigate and respond to complaints and appeals
- Communicate response to member or their authorized representative and physician within internal and regulatory timeframes
- Thoroughly document complaint and appeal files
- Weekly review of colleague's cases to ensure they are meeting compliance and performance requirements
- Review colleague's complaint or appeal outcome letters to confirm they meet compliance requirements before being sent to the member and their provider
- Facilitate Member Rights and Benefits team meetings on a regular basis.
Member Services Representative
HealthPartners
08.2013 - 02.2014
- Answer questions from members and prospective members about plan network and benefits
- Coordinate problem resolution with internal departments on behalf of callers
- Proficiently use systems, work tools, and resources needed to provide accurate information
- Meet specific department goals related to quality and quantity of calls.
Lead Quality Assurance Supervisor
Northland Group, Inc.
06.2011 - 07.2013
- Took escalated supervisor calls
- Managed email correspondence to and from customers
- Performed internal call monitors
- Performed external client audits
- Trained new Quality Assurance representatives
- Ensured other Quality Assurance Supervisors knew what tasks needed to be completed and that they were completing them in a timely manner.
Education
Bachelor of Science -
University of Wisconsin-Eau Claire
05.2010
Skills
- Information Security
- Network Administration
- Performance Benchmarking
- Scalability planning
- Business Analysis
- Software Management
- Business Development
- Project Management
- Strategic Planning
- Project Documentation
Timeline
Senior Consultant & Project Lead, Member Rights and Benefits
HealthPartners
08.2017 - Current
Consultant, Member Rights and Benefits
HealthPartners
02.2014 - 03.2016
Member Services Representative
HealthPartners
08.2013 - 02.2014
Lead Quality Assurance Supervisor
Northland Group, Inc.
06.2011 - 07.2013
Senior Consultant, Member Rights and Benefits
HealthPartners
2016 - Current
Bachelor of Science -
University of Wisconsin-Eau Claire
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