Lori Kuykendall

• Responsible for leading a large team consisting of project managers, IT developers, architects, business analysts, and various vendors to create and implement a new system to in-house government business across Illinois, New Mexico, Montana, Oklahoma, and Texas
• Accountable for the client interface, coding benefits and processing claims
• Proficient in defining and executing business, operational and regulatory programs using both a customer-focused and analytical results-oriented approach to drive quality, compliance and operational excellence
• Ensured strict compliance with all state and federal laws regarding benefit coverage
• Promoted throughout tenure with the Health Care Service Corporation for exceptional contributions and key achievements; consistently surpasses key objectives and assumes increasing responsibilities
• Coordinated teams in operational and regulatory programs using both a customer-focus and analytical, results-oriented approach to drive quality, compliance, and operational-excellence
• Experienced leader skilled at building trust with leaders, staff, vendors and clients to facilitate change
• Drove operational performance and delivered expert-level support and strategic guidance, fostered positive work environment and effectively delegated assignments

• Oversee the coding team for pharmacy benefits for commercial, state, federal and retail accounts consisting of over 22,500,000 members across Illinois, New Mexico, Montana, Oklahoma and Texas
• Provided influential leadership and coaching to teams working with inquiries and issues and deliver strategic guidance and training to optimize client service
• Coordinated activities between HCSC and the Pharmacy Benefit Manager (PBM) vendor to achieve accurate and timely results for clients
• Achieved a 77% reduction in coding errors and a 59% reduction in the number of members not ready by January 1st; effectively managed inventory through year-end and optimized corporate activity
• Led quality assurance initiatives; work closely with PBM vendor to update reporting systems between HCSC and PBM, resulting in an increase in the quality of work and expedited key processes
• Led team training, quality improvements and production improvements resulting in a reduction of incorrectly paid claims by 98% over a 4 year period, saving HCSC and clients $5.9 million
• Identified procedures for automation, led multi-faceted team to create automation resulting in a reduction of 75% of clients requiring manual review and increased productivity

• Provided influential leadership, coaching, and mentorship to Texas and New Mexico Analysts and Texas Functional Equivalent Accumulator Key (FEAK) team and led training programs to maximize staff potential
• Challenge: Identify a solution for the Texas accounts to expedite operations and transform the results of an underperforming team
• Action: Conducted analyses and tests to identify solutions and reallocated assignments to cross-functional departments
• Result: Decreased time spent by 54%, increased team quality and performance, reduced time to complete accounts by 50% and saved 1,124 testing hours
• Achieved a 202% increase in 1/1 membership production ready metrics in Texas year-over-year by leading an enterprise FEAK workgroup
• Influenced process improvements and drove internal results
• Developed new reporting tools to enhance the medical claims lock report utilized by multiple internal business partners
• Implemented and strictly enforced federal and state regulations, including the Affordable Care Act (ACA), ICD-10, MAR audit, and SOC1 audit; acted as the company's Ethics & Compliance Ambassador

• Delivered world class customer service and support and created a positive customer experience; responded to inquiries, questions, or requests, effectively resolved complex complaints, and optimized satisfaction rates
• Acted as the direct point-of-contact for all assigned brokers and accounts; led underwriting / negotiation tasks
• Collaborated with account executives to influence process-improvements to develop creative solutions to internal challenges and enhance the customer experience; consistently surpassed goals, conducted wellness meetings with clients and increased insurance proficiency with members
• Facilitated and led effective training programs to maximize the potential of the customer consultants

• Created documentation on the use of a reporting tool to maximize functionality and performance throughout the team
• Produced comprehensive inventory, production, and quality data reports for management teams; managed and maintained inventory, conducted key inventory audits, and ensured accuracy to prevent losses
• Developed the reporting tool for quality, production, and inventory data and created a new paperwork intake process, which was implemented enterprise-wide
• Optimized efficiency and accuracy

Performance Specialist (2005 - 2008)

Claim Coordinator (2005)

Customer Service Technician (2002 - 2005)

Customer Service Rep (2001 - 2002)

Claims Processor (2000 - 2001)