Stacey Evans
Enola,PA
Summary
Proven Senior Analyst at Aetna, a CVS Health, excels in client relationship management and data analysis, driving operational improvements and enhancing client satisfaction. Leveraged analytical thinking and Excel proficiency to develop key performance indicators, achieving significant efficiency gains. Demonstrates exceptional team collaboration and leadership, ensuring project deliverables meet stringent deadlines.
Senior analyst with robust background in data analysis, financial modeling, and strategic planning. Known for strong collaboration skills and adaptability in fast-paced environments. Adept at leveraging advanced analytical tools and methodologies to drive impactful business decisions. Consistently delivers results through teamwork and solutions-focused approach.
Overview
31
31
years of professional experience
Work History
Senior Analyst, Plan Sponsor
Aetna, a CVS Health
07.2020 - Current
- Foster relationship with Northwell Health System - largest healthcare system on the East coast
- Collaborated with cross-functional teams to identify areas of improvement, leading to increased operational effectiveness.
- Improved company efficiency with the development of key performance indicators and tracking metrics.
- Optimized project management, resulting in timely deliverables and improved client satisfaction rates.
- Analyzed data to identify root causes of problems and recommend corrective actions.
- Identify contract discrepancies causing incorrect claim payment
- Collaborate with Network, Appeals, claims, and TPA's to resolve claim payment issues
- Compile tip sheets for claim processors around the contract intricacies of Northwell Health System.
- Review all claims for correct processing per contract and Aetna policy (Medicare, IVL, Commercial, Medicaid and Foreign claims).
- Submit claims projects for errors in claim processing that exceeds 25 affected claims.
- Schedule and facilitate meetings with six departments within Northwell Health Systems to review claim spreadsheet and discuss trends.
Senior Claims Processor
Aetna, a CVS Health
07.2019 - 07.2020
- Improved claim processing efficiency by streamlining workflows and implementing best practices.
- Supported continuous improvement initiatives within the organization by suggesting innovative solutions to challenges faced in the claims process.
- Monitored regulatory compliance within the department, adhering to all relevant state and federal guidelines.
- Reduced errors in claims processing through rigorous quality control measures.
- Developed training materials for staff development, leading to increased productivity and team cohesion.
- Managed high-volume caseloads, ensuring timely and accurate completion of claims processing tasks.
- Ensured accuracy of financial transactions related to claim payments, minimizing discrepancies in company records.
- Reviewed complex claims, utilizing expert knowledge to ensure proper coverage determinations were made.
- Mentored junior processors, enhancing their knowledge and skills for improved job performance.
- Collaborated with cross-functional teams to improve overall claims management processes.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing meet deadlines.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Checked documentation for accuracy and validity on updated systems.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Maintained confidentiality of patient records, and health statuses.
Customer Service Supervisor
Aetna, a CVS Health
06.2015 - 07.2019
- Promoted a positive work environment through open communication channels, fostering team collaboration and high morale.
- Collaborated with other departments to address recurring customer concerns, improving overall service quality.
- Coached employees through day-to-day work and complex problems.
- Improved customer satisfaction by addressing and resolving escalated issues promptly and professionally.
- Enhanced team productivity through regular coaching, feedback, and performance evaluations.
- Maintained up-to-date knowledge of company products and services, effectively communicating changes to the team for seamless customer support.
- Demonstrated exceptional problem-solving abilities in navigating challenging customer scenarios and finding solutions that met their needs as well as aligned with company policies.
- Managed escalated calls with diplomacy, successfully deescalating situations while ensuring satisfactory resolutions for both parties involved.
- Coached team members to deliver hospitable, professional service while adhering to set service models.
- Responded to customer inquiries and resolved complaints to establish trust and increase satisfaction.
- Assessed team performance through regular reporting, identifying opportunities for further skill development and training initiatives.
- Actively supported service associates by quickly responding to questions via phone and email and finding appropriate solutions to customer issues.
- Led regular customer service meetings to review progress identify challenges and provide feedback.
- Evaluated individual performance metrics to identify areas of improvement, providing targeted coaching to boost results.
- Conducted regular quality assurance checks on team interactions with customers, ensuring adherence to company standards.
- Created, prepared, and delivered reports to various departments.
- Monitored call center data to assess trends, proactively implementing solutions for identified issues.
- Championed a customer-centric approach within the team, consistently encouraging empathy and understanding when interacting with clients.
- Facilitated cross-functional initiatives between teams for improved coordination in addressing complex customer needs.
- Led by example, handling complex customer issues personally to ensure high standards of service.
- Facilitated team meetings to discuss performance metrics and areas for improvement.
- Monitored and analyzed call metrics to identify trends and areas for process enhancement.
- Resolved escalated customer complaints, ensuring satisfaction and loyalty.
Senior Cross Functional Representative
Aetna, a CVS Health
09.2003 - 06.2015
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Managed workload and priorities to meet claims processing meet deadlines.
- Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Evaluated accuracy and quality of data entered into agency management system.
- Followed up with customers on unresolved issues.
- Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Maintained strict confidentiality when dealing with sensitive information about patients'' medical histories or personal details.
- Identified fraudulent claims through thorough investigation and documentation of findings.
- Tracked and reported on claims processing metrics to aid senior management in making informed decisions.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Provided support during internal and external audits, ensuring accurate representation of the company''s claim history.
- Monitored changes in legislation that could potentially impact the way claims are processed or paid out by insurance companies.
- Participated in various professional development opportunities to stay current on industry regulations, best practices, and emerging technologies relevant to claim processing activities.
- Increased team productivity by leading training sessions on best practices for claims processing.
- Reduced backlog of pending claims, prioritizing tasks effectively and efficiently.
- Enhanced accuracy of claims assessments, conducting thorough investigations and leveraging expert evaluations.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Coordinated with contracting department to resolve payer issues.
Insurance Specialist
Health South Rehab
02.2001 - 09.2003
- Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
- Processed eligibility and benefits verification and authorization requests.
- Followed up on denials, late payments, extensions and other special circumstances.
- Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
- Maintained high standards of customer service by building relationships with clients.
- Communicated effectively with members of operations, finance, and clinical departments.
- Acted as subject matter expert, answering internal and external questions and inquiries.
- Researched and resolved routine and complex issues.
- Ensured regulatory compliance through diligent monitoring of company practices and adherence to guidelines.
- Maintained confidentiality of patient finances, records, and health statuses.
- Responded to customer calls swiftly to resolve issues and answer questions.
- Built relationships with clients using active listening and issue resolution to provide excellent service.
- Educated clients on insurance policies and procedures.
Dental Claims Processor/Dental Customer Service
Delta Dental
03.1994 - 02.2001
- Maintained a high level of accuracy in data entry while processing large volumes of dental claims daily.
- Promoted a supportive work environment within the team, sharing knowledge about best practices for efficient claims handling.
- Collaborated with other departments as needed, providing insight into specific aspects of dental claims that impacted their work.
- Reduced claim errors by diligently verifying patient eligibility and coverage details before processing.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Maintained confidentiality of patient records, and health statuses.
- Contributed to overall department success by regularly meeting or exceeding individual productivity goals and maintaining a low error rate in claim adjudication.
- Supported department goals through consistent achievement of productivity benchmarks and quality metrics in claim processing.
- Minimized processing delays due to incorrect information or missing documentation by proactively reaching out to relevant parties.
- Prevented fraud by identifying discrepancies in submitted documentation and following up accordingly.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Answered incoming calls from Dental providers and members.
- Placed outbound calls to Dental providers and members.
- Passionate about learning and committed to continual improvement.
- Worked flexible hours across night, weekend, and holiday shifts.
- Organized and detail-oriented with a strong work ethic.
Education
Bachelor of Science - Healthcare Administration
University of Arizona Global Campus
Tucson, AZ08-2023
No Degree - Dental Assistant
York College of Pennsylvania
York, PA05-1995
Skills
- Client management
- Client relationship management
- Data analysis
- Performance monitoring
- Report preparation
- Network management
- Business intelligence
- Cloud-based technologies
- Analytical thinking
- MS Excel
- Deadline adherence
- Team collaboration and leadership
- Root-cause analysis
- Documentation and reporting
- Regulatory compliance
- Data research and validation
- Excel proficiency
- Data processing
- Information gathering
- Trend forecasting
- Time management
- Attention to detail
- Critical thinking
- Verbal and written communication
- Decision-making
- Microsoft office
- Analytical problem solving
- Complex Problem-solving
- Research and analysis
- Performance tracking
- Data interpretation
Timeline
Senior Analyst, Plan Sponsor
Aetna, a CVS Health
07.2020 - Current
Senior Claims Processor
Aetna, a CVS Health
07.2019 - 07.2020
Customer Service Supervisor
Aetna, a CVS Health
06.2015 - 07.2019
Senior Cross Functional Representative
Aetna, a CVS Health
09.2003 - 06.2015
Insurance Specialist
Health South Rehab
02.2001 - 09.2003
Dental Claims Processor/Dental Customer Service
Delta Dental
03.1994 - 02.2001
Bachelor of Science - Healthcare Administration
University of Arizona Global Campus
No Degree - Dental Assistant
York College of Pennsylvania
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