Laura Chevrette
South Lyon,Mi
Summary
18+ years experience in successfully leading teams and projects, with a focus in quality improvement. Throughout my career, I have always put my focus on employee growth and development. I have a strong ability to build relationships across different functional areas, which has allowed me to achieve success in both daily operations and larger scale projects. I thrive in environments where things are always changing and consistently look for ways to do things better and faster, with a goal on reducing administrative costs.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Director of Compliance
Oscar Health Insurance
02.2022 - Current
- Consulted with clients on best practices and served as project manager for all process improvements and regulatory initiatives.
- Strengthened relationships with regulators through proactive communication and collaboration efforts.
- Evaluated proposed business initiatives from a compliance perspective, providing guidance on potential risks or concerns.
- Conducted periodic reviews of company policies to ensure alignment with current regulations.
- Managed practical action plans to respond to audit discoveries and compliance violations.
- Monitored and assessed compliance risks associated with operational processes and procedures.
- Championed a culture of compliance within the organization, fostering employee awareness and commitment to ethical conduct.
- Addressed compliance issues by developing and implementing corrective action plans.
- Provided oversight of internal and external audits to confirm compliance with applicable laws and regulations.
- Developed and maintained system for tracking and reporting compliance violations.
- Assisted with internal and external audits to confirm compliance with applicable laws and regulations.
- Enhanced internal audit capabilities by creating comprehensive checklists and guidelines.
- Implemented effective compliance policies and procedures to meet regulatory requirements.
- Collaborated with contract team to review client contracts and facilitate personnel compliance training.
- Collaborated with legal counsel to develop accurate interpretations of new or changing regulations.
- Prepared and presented comprehensive reports to upper management and audit team, covering issues and recommendations.
- Identified, investigated and documented compliance violations and recommended corrective measures.
- Maintained up-to-date knowledge of current and emerging compliance regulations.
- Managed full life cycle of assigned audits in alignment with departmental procedures, delivering progress as well as closing reports to senior management and clients.
- Developed risk mitigation strategies for effective regulatory compliance across the organization.
- Served as subject matter expert for internal teams regarding federal, state, and local regulatory requirements.
- Reduced regulatory risks by conducting thorough due diligence on third-party vendors and partners.
- Analyzed and identified risk areas to determine compliance with applicable laws and regulations.
- Identified areas for improvement through regular gap assessments, driving continuous enhancements to the compliance program.
- Facilitated open lines of communication between departments concerning ongoing regulatory changes and their impact on operations.
- Coordinated responses to regulator inquiries or examinations, ensuring prompt attention to critical issues.
Health Care Manager – Pharmacy Services
Blue Cross Blue Shield of Michigan
01.2021 - 01.2022
- Responsible for coordinating systems access to OptumRx suite of applications for 3,000 end users
- Coordinate with corporate data security and IT teams to develop access roles, attestation reports, and knowledge articles for corporate IT helpdesk
- Collaborate across departments to identify training needs; scheduled training for 3,000 internal and external employees
- Developed Business Readiness Documents and scope statements
- Coordinated command center calls and created ticket escalation process
- Entered in weekly status updates in JIRA; coordinated with scrum masters on deliverables
- Developed new provider facing pages in digital space
- Perform weekly executive leader readouts
- Lead weekly RAID (risks, assumptions, issues, dependencies) log meetings.
Health Care Manager- Pharmacy Services
Blue Cross Blue Shield of Michigan
07.2019 - 01.2022
- Work directly with Pharmacy Benefit manager account leadership on executive escalations, eligibility, and benefits
- Oversight of group customer and corporate audits
- Serve as subject matter expert on Request for Proposals
- Oversight of Model Audit Rule and System and Organization Controls Reporting
- Work closely with regulatory and legal departments to interpret guidance and implement policy changes
- Oversight of all Utilization Management activities related to National Committee of Quality Assurance, CMS, and state and federal regulations for our commercial book of business and Qualified Health Plans; achieving Blue Care Network Accreditation in the August 2020 survey
- Work closely with digital experience and the provider engagement team on both member and providing facing pages, improving the end user experience
- Manage and coordinate annual policy review for the pharmacy department
- Lead the team that monitors all retail pharmacy claims and implements controls to ensure claim accuracy
- Analyze mail order complaints, determine root cause and resolution path
- Successful implementation of electronic prior authorization; improving adoption from 30% to almost 70% for the commercial retail business
- Developed and implemented a cross training plan for Covid contingency planning.
Health Care Manager- Pharmacy Services
Blue Cross Blue Shield of Michigan
10.2016 - 07.2019
- Oversight of prior authorization clinical helpdesk for drugs covered under the pharmacy and medical benefit, leading a team of 40+ prior authorization specialists, analysts, and team leaders
- Extensive knowledge of National Committee for Quality Assurance and CMS; participation in two accreditation surveys, as well as multitude of internal and external audits and annual data validation
- Maintain and build cross functional relationships, working with various stakeholders across the enterprise
- Implemented a new integrated voice response system which resulted in yearly administrative savings
- Implemented a helpdesk for medical drug authorizations and fully integrated the HMO and PPO lines of business, bringing average Telephone Servicing Factor from a 50% to over 90% in one quarter
- Responsible for meeting all performance guarantees (Telephone Servicing Factor, ASA, and abandonment rate) monthly by ensuring proper staffing levels are maintained and productivity standards met.
Team Lead II- Medicare Advantage Call Center
Blue Cross Blue Shield of Michigan
06.2014 - 10.2016
- Subject Matter Expert in CMS; with a specific focus on Part B and Part D
- Provide real time coaching, motivation, mentoring, development, and recognition for team leaders and analysts
- Monitor processes and budgets to ensure operational standards, customer specific performance guarantees, and CMS regulations are met in a fiscally responsible manner
- Maintain vendor relationships for contact centers at multiple locations
- Implemented and executed programs to increase overall First Call Resolution, reduce average handle time
- Utilize text analytics to analyze call data, identify trends and monthly call drivers
- Engage customer experience and Centers of Excellence team for member experience initiatives to improve overall STARS rating
- Utilize First Call Resolution data and Customer Service Representative performance reporting to identify performance outliers, coach accordingly
- Follow up on all member escalations swiftly and ensure processes/associate performance is addressed
- Work closely with workforce management team to ensure proper staffing and forecasts are maintained.
Education
University of Michigan
07.2021
BBA in Management -
Eastern Michigan University
12.2008
Skills
- Mondaycom project management software
- Microsoft Suite
- Internal Audits
- Internal Controls
- Salesforce
- Tableau
- PeopleSoft
Areas Of Effectiveness
- Conflict resolution and negotiation
- Proficiency in Outlook, Excel, PowerPoint, Word, Access, SAS, Oracle, PeopleSoft, OneDrive, SharePoint, Tableau, Salesforce
- Adapting to changing priorities
- Making sound business judgments
- Working under pressure, short deadlines and urgent situations
- Excellent follow up skills and the ability to handle multiple projects
- Project management and the ability to cross collaborate
Certification
Six Sigma Green Belt - University Of Michigan
Timeline
Director of Compliance
Oscar Health Insurance
02.2022 - Current
Health Care Manager – Pharmacy Services
Blue Cross Blue Shield of Michigan
01.2021 - 01.2022
Health Care Manager- Pharmacy Services
Blue Cross Blue Shield of Michigan
07.2019 - 01.2022
Health Care Manager- Pharmacy Services
Blue Cross Blue Shield of Michigan
10.2016 - 07.2019
Team Lead II- Medicare Advantage Call Center
Blue Cross Blue Shield of Michigan
06.2014 - 10.2016
University of Michigan
BBA in Management -
Eastern Michigan University