LORETTA MAIDENS
Marcellus,NY
Summary
A professional delivering executive support and team leadership to business organizations. Dependable and result-oriented to manage multiple tasks and priorities. Broad experience includes insurance claims, customer service, mailroom and support services leadership; employee engagement focus; change management; employee relations management; leadership mentoring; banking; and tax professional.
Looking forward to working with a team of engaged individuals with a passion for achieving excellence, creating efficiencies, developing staff, and acting with a high level of integrity and a strong work ethic.
Overview
32
32
years of professional experience
1
1
Certification
Work History
Claim Operations Manager
Smart Data Solutions
Eagan, MN
08.2023 - Current
- Successfully managed and supervised a team of 30 staff responsible for performing BPO medical claims processing and audit activities, contributing to the growth of a new line of business within the organization.
- Achieved improved performance coaching and employee development by successfully executing initiatives while addressing employee relations concerns.
- Led the development of reporting capabilities, recruitment strategies, policy/procedure implementation, inventory management procedures, personnel supervision techniques, training programs and audit procedures.
Quality & Audit Associate Director
NTT Data
Quincy, MA
05.2022 - 08.2023
- Managed and directed a team of 30 employees engaged in performing audit activities to facilitate the smooth functioning of a BPO medical claim operation. Duties included overseeing data entry, enrollment processes, and conducting thorough claim audits.
- Led activities for Performance Guarantees, Internal Audit, External Audit, and RFP responses.
- Aided leadership team by executing successful initiatives for employee development, performance coaching, progressive discipline practices, and resolving employee relations issues.
- Successfully revitalized departmental results by executing a comprehensive QA Restoration Plan. This involved restructuring team dynamics, redefining audit complexity levels, implementing strategies like globalizing tasks, vacation planning, and purifying the bonus program. Additionally, improved communications were achieved through employee recognition initiatives, department meetings, and enhanced reporting metrics.
Call & Claim Manager
UMR / United HealthCare
Syracuse, New York
10.2016 - 05.2022
- Directed a group encompassing approximately 100 team members who were responsible for handling medical claim processing and addressing customer service inquiries in an inbound call center.
- Maintained oversight of local mailroom personnel, support staff, and daily activities.
- Executed successful initiatives for employee development, performance coaching, progressive discipline practices, and resolving employee relations issues.
- Enhanced leadership abilities through the implementation of Start/Stop/Continue exercises for professional development.
- Managed transition efforts from POMCO to UMR by implementing robust change management strategies, delivering comprehensive training programs and providing ongoing support.
- Took charge of multiple office and network projects, namely Business Goal Setting, Learn Anywhere Interview Process, and Employee Engagement Committee Leader.
- Achieved successful completion of the Emerging Leaders Program as a participant, followed by assuming responsibility as a small group cohort leader supporting two groups - one situated in the USA and another based in India.
Claim & Mailroom Supervisor
UMR / United HealthCare (POMCO)
Syracuse, New York
08.2014 - 09.2016
- Oversaw the activities of a multi-functional team comprising 15-18 members engaged in processing claims, negotiating claim settlements, providing support services and managing mailroom operations.
Director for Short-Term Disability
The Hartford
Syracuse, New York
07.2008 - 12.2013
- Managed a team of approximately 60 employees responsible for adjudicating STD claims
- Achieved an impressive 80% reduction in claim turn-around-time by implementing effective initiatives. Key actions included modifying workflow distribution to increase examiner caseload accountability, while also identifying performance strengths and areas for growth.
- Awarded for outstanding customer service performance across the network. Implemented collaborative analysis efforts involving staff and leaders from all levels of responsibility to evaluate claim and call scenarios with subpar results.
- Aided leadership team by executing successful initiatives for employee development, performance coaching, progressive discipline practices, and resolving employee relations issues.
- Managed various office and network initiatives, such as Claim Excellence, NJ Statutory Remediation, and Statutory Training projects. Collaborated in Quarterly Business Reviews (QBR).
- Cultivated stronger leadership skills by facilitating Start/Stop/Continue exercises for professional growth.
- Led operational improvements through Claims Advantage Program, including Process Optimization, Disability Model Evaluation, STD Restructure, and Claim Excellence.
- Assisted with streamlining operations and contributed to an individual claim team's success during the final 10 months at The Hartford before the office closure.
Assistant Director for Short-Term Disability
The Hartford
Syracuse, New York
07.2006 - 06.2008
- Contributed to the leadership of a 100+ member team within a Claim Adjudication organization and Customer Contact Center, with direct oversight of Clinical arena as well as technical Claim Specialists
- Engaged in diverse office and network projects geared towards boosting efficiency. Notable endeavors involve overhauling the STD/LTD Quality Assurance Program, performing a meticulous evaluation of the Claim Process Review, overseeing development and communication of NJ Check Routing, as well as implementing measures to enhance Taxability execution.
- Demonstrated successful completion of the Emerging Leaders Program as an active participant.
Team Leader for Customer Service
The Hartford
Syracuse, New York
08.1998 - 06.2006
- Managed large teams of Customer Service Representatives in an inbound call center, ensuring delivery of high-quality service to our valued customers.
- Developed and executed an advanced QA framework, later adopted as the foundation for a network-wide QA initiative.
- Created a comprehensive 'Telephonic Initial Claim Intake Questions' document utilized in sales presentations to onboard prospective clients.
- Managed the recruitment process for all staff members at the New York office.
- Efficiently oversaw the integration of two call centers, resulting in a single streamlined operation.
Team Leader for Support Services
The Hartford
Syracuse, New York
01.1992 - 07.1998
- Achieved efficient workflow by overseeing a team of 7-10 Clerks who managed tasks such as sorting and distributing mail, researching unidentified mail, filing, and offering general clerical support to the Short-Term and Long-Term Disability departments.
- Implemented various initiatives such as time studies, process enhancements, and role modifications to optimize performance.
- Provided valuable insights through workflow analysis in different claim offices, resulting in recommended improvements for their Support teams.
Skills
- Employee Engagement
- Data and Root Cause Analysis
- Expense Management
- Quality Analysis
- Customer Service Excellence
- Performance Management
- Succession Planning
- Intermediate Excel Experience
- Effective Communication
- Employee Relations
- Vendor Relationship Management
- Staff Training and Development
- Workflow Analysis
- Conflict Resolution Techniques
- Claims Processing & Investigation
- Policy Interpretation
- Project Management
- Leadership Development
- Critical Thinking
- Innovative Thinking
- Resource Allocation
- Customer Relations
- Inventory Management
- Department Oversight
- KPI Tracking
- Team Collaboration
- Process Improvements
- Adaptability and Flexibility
- Change Management
- Operations Oversight
- Strategic Planning
- Decision-Making
- Time management abilities
- Recruitment
- Continuous Improvement
- Delegation
- Teamwork and Collaboration
Commentary
'Loretta's eye for detail, relentless pursuit for operational excellence, and ability to communicate at all echelons of the organization have earned her a standing position of respect in the client business and operational ranks.'
'Loretta has demonstrated her ability to design and implement strategies that maximize employee potential, connects the organization horizontally and vertically, and fosters high ethical standards in meeting the organizations vision, mission, and goals.'
'Loretta has created an inclusive workplace that fosters the development of others to their full potential; allows for full participation by all employees, facilitates collaboration, cooperation, and teamwork, and supports constructive resolution of conflicts.'
Certification
- Emerging Leader Program
- Managing Forward - PLS Certification
- Health Insurance Association of America (HIAA) I, II & III
- Microsoft Excel Workshop Lvl II
- Insurance Claim Association (ICA) Parts C1, C2 & C4
- Independent Adjuster Accident & Health (2014-2022)
- People Management Essentials
- Fred Pryor - Dealing with Difficult People NYS
- The Seven Habits of Highly Effective People
- Emotional Intelligence Leadership courses
Community Involvement
Bandera Family Free Christmas Dinner (28 years in Binghamton, NY) - family led event serving approximately 3000 meals on Christmas day.
Sleep in Heavenly Peace, Samaritan Center, and Feed My Starving Children - engaged on multiple occasions with organizing community events with new hire classes and existing staff at UMR.
Auburn Church of the Nazarene - Treasurer; Compassionate Ministries Leader; Labor For Your Neighbor; Nursery & Youth support; Worship Team;
Bagged Lunches & Care Packages for Homeless - personal mission to support the Homeless in Central New York.
Run for Recovery (3 years) - donate & participate in 5k events to support people recovering from substance abuse and mental illness.
American Heart Association
American Cancer Society
American Diabetes Association
K-Love Radio Network
Timeline
Claim Operations Manager
Smart Data Solutions
08.2023 - Current
Quality & Audit Associate Director
NTT Data
05.2022 - 08.2023
Call & Claim Manager
UMR / United HealthCare
10.2016 - 05.2022
Claim & Mailroom Supervisor
UMR / United HealthCare (POMCO)
08.2014 - 09.2016
Director for Short-Term Disability
The Hartford
07.2008 - 12.2013
Assistant Director for Short-Term Disability
The Hartford
07.2006 - 06.2008
Team Leader for Customer Service
The Hartford
08.1998 - 06.2006
Team Leader for Support Services
The Hartford
01.1992 - 07.1998