Michelle Arnold
Wilmington,DE
Summary
Results-driven professional with over 35 years in auto claim management and pharmaceutical utilization claims and contracting. Demonstrates strong detail orientation alongside exceptional communication and interpersonal skills. Proficient in Microsoft Office, with advanced auditing, research, and analytical capabilities that drive process improvements and enhance operational efficiency. Aiming to leverage extensive experience to contribute to innovative claims solutions.
Overview
37
37
years of professional experience
Work History
Contract Operations Manager
AstraZeneca Pharmaceuticals
Wilmington, DE
01.2019 - Current
- Responsible for processing, validating and reconciling all contractual payments for assigned regional Health Plans, PBM’s and Medicare Part D customer segments
- Review and interpretate contract language as it relates to contract setup and maintenance to ensure accurate calculation of customer reimbursements
- Assisted with contract builds and accurate setup of rebate program strategies upon implementation of Model N system
- Maintained strong partnerships with Account Directors to communicate formulary compliance issues as well at utilization, sales and rebate information
- Project lead for implementation of Validata Bot for automation of utilization based claims
- Project participant for implementation for several projects that led to reduction in revenue leakage
Trade Operations Analyst
AstraZeneca Pharmaceuticals
Wilmington, DE
01.2018 - 01.2019
- Worked with internal/external customers on all aspects of Market Access, Primarily Membership, Chargebacks and Rebates
- Review, process, research and validate Chargebacks to ensure they are paid correctly and timely
- Work with Membership and Contracting teams to ensure accuracy of membership rosters
- Develop and maintain strong working relationships with internal and external customers as it relates to Chargebacks and 340B Refund Process
- Understanding of compliance related requirements and adhere to audit controls, policies, SOP’s and job aids
- Successfully completed project management initiatives to streamline the 340B Refund Process and developed training guides for Trade Operations team members to support Market Access objectives
Casualty Claim Specialist
State Farm Insurance Company
Concordville, PA
01.2016 - 02.2018
- Investigated, evaluated, and negotiated casualty liability claims in assigned areas as presented by gathering information regarding coverage questions, damages and settlement value
- Collaborated with legal counsel to effectively resolve litigated claims with complex insurance contract coverage issues
- Served as a resource for local jurisdictional issues involving third-party loss handling
- Assisted in training and/or mentoring less experienced Claim Specialists
- Participated in special projects as assigned
Claim Automation & Procedure Specialist
State Farm Insurance Company
Concordville, PA
01.2014 - 01.2016
- Provided claim automation and procedures support to Auto Claim Segments
- Provided continuous training to new and existing employees on all procedures, automated tools and new company policies
- Project management including analysis, planning, coordination of resources and implementation
- Analyzed workflows, integrated automation and procedures into existing workflows and made efficiency recommendations to management
- Developed and prepared written reports and training materials
- Interacted with new computer technologies
Claim Representative
State Farm Insurance Company
Concordville, PA
01.2011 - 01.2014
- Investigated, evaluated, and negotiated non-litigated motor vehicle total loss claims in multiple jurisdictions as presented by gathering information regarding coverage questions, damages and settlement value
- Collaborated with policyholders, third party claimants and attorneys to amicably resolve disputed value claims
Claim Manager
Nationwide Insurance Company
Newark, DE
01.2005 - 01.2011
- Liability claims manager responsible for performance management, salary planning and administration, training and development, workflow planning, and hiring and placement
- Drove technical excellence, managed productivity by conducting open file reviews, reinforcing corporate communications, and enforcing compliance regulations
- Researched and resolved Department of Insurance complaints as well as 1st and 3rd party complaints concerning customer dissatisfaction with coverage and liability outcomes
- Identified and resolved ethical dilemmas, managed general personnel issues
- Lead local recruiting teams and actively partnered with HR and claims leadership to develop an annual workforce plan
Claim Representative
Nationwide Insurance Company
Newark, DE
01.2002 - 01.2005
- Investigated, evaluated, negotiated and settle injury and non-injury auto claims in assigned areas as presented by investigating and gathering information regarding legal liability, coverage questions, and injuries
- Gathered statements from policyholders, claimants, and witnesses and secured medical reports and police reports
- Secure photos of scene and/or damages to property involved
- Verified wage losses, and other medical expense
- Corresponded with attorneys and claimants to gather information regarding liability
Health and Policy Administrative Assistant
State Farm Insurance Company
Concordville, PA
01.1988 - 01.2002
- Held progressive roles of responsibility from Health and Policy Administrative Assistant, Senior Benefits Specialist to Senior Claim Processor, as well as Casualty Claims Representative
Education
Bachelor of Arts - Organizational Dynamics
Immaculata College
Immaculata, PAAssociates of Science - Business Management
Immaculata College
Immaculata, PASkills
- Excellent oral and written communication
- Strong interpersonal communication
- Strong analytical thinking
- Problem-solving abilities
- Multitasking
- Effective leader
- Problem-solving aptitude
- Forecasting
- Reliability
- Contract Negotiation
- Procurement
- Team building
- Adaptability
- Project Management
- Staff Training
- Time management abilities
- Process Improvement
References
References available upon request.
Timeline
Contract Operations Manager
AstraZeneca Pharmaceuticals
01.2019 - Current
Trade Operations Analyst
AstraZeneca Pharmaceuticals
01.2018 - 01.2019
Casualty Claim Specialist
State Farm Insurance Company
01.2016 - 02.2018
Claim Automation & Procedure Specialist
State Farm Insurance Company
01.2014 - 01.2016
Claim Representative
State Farm Insurance Company
01.2011 - 01.2014
Claim Manager
Nationwide Insurance Company
01.2005 - 01.2011
Claim Representative
Nationwide Insurance Company
01.2002 - 01.2005
Health and Policy Administrative Assistant
State Farm Insurance Company
01.1988 - 01.2002
Bachelor of Arts - Organizational Dynamics
Immaculata College
Associates of Science - Business Management
Immaculata College
Similar Profiles
Lucas LopezLucas Lopez
Formulation Technician at AstraZeneca PharmaceuticalsFormulation Technician at AstraZeneca Pharmaceuticals
Timothy JoyceTimothy Joyce
Material Handler III at AstraZeneca PharmaceuticalsMaterial Handler III at AstraZeneca Pharmaceuticals
Elanur AkdemirElanur Akdemir
Human Resources Specialist at AstraZeneca PharmaceuticalsHuman Resources Specialist at AstraZeneca Pharmaceuticals
Michael TimponeMichael Timpone
Executive District Sales Manager – Respiratory Specialty & Immunology (NY/NJ) at AstraZeneca PharmaceuticalsExecutive District Sales Manager – Respiratory Specialty & Immunology (NY/NJ) at AstraZeneca Pharmaceuticals
Edward DiMauro JrEdward DiMauro Jr
Firefighter at Minquadale Fire CompanyFirefighter at Minquadale Fire Company