Summary
Overview
Work History
Education
Skills
Timeline
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TRACI L. BAKER

TRACI L. BAKER

Antioch,TN

Summary

I am a highly experienced individual and I understand accountability is invaluable in professional growth and success. I have 18 years of experience in the healthcare industry where I have worked in numerous departments and roles which involved direct client interaction, medical claim review and processing, member benefits, training, and mentoring. I take pride in my ability to build strong relationships and adapting to an ever-changing environment. QUALIFICATIONS: Exceptional customer service skills Extensive experience in direct client facing positions including, but not limited to, renewals, escalated issues, summary plan descriptions, benefits, etc. Adapts well in a changing environment. Results-driven Sales Manager bringing years of experience in product development, promotion and optimization. Skilled in developing lasting client rapport based on knowledgeable support and consistent service. Demonstrated success in building networks and supporting branding objectives.

Overview

19
19
years of professional experience

Work History

Regional Service Manager

Cigna
Nashville, TN
06.2023 - 01.2025
  • Provide feedback to senior leadership for service policies and procedures to ensure customer satisfaction.
  • Maintained records of customer feedback, complaints, and suggestions for improvement.
  • Work as a strategic partner with leadership across 4 markets for sales, client management, new business, implementation, and retention.
  • Assist in developing policies, procedures, and workflows.
  • Conducted monthly performance reviews with staff to identify areas of improvement.
  • Resolved conflicts between CSCs, brokers, clients, or other personnel within the regions.
  • Developed strategies for improving overall customer experience through better communication practices.
  • Identified training needs among staff members in order to maintain high quality standards.
  • Established relationships with key matrix partners and external clients.
  • Provided guidance and advice on best practices for resolving difficult customer service cases.

Client Manager

OPTUM
Franklin, Tennessee
01.2021 - 03.2023
  • Establish effective relationships with assigned clients and gain an understanding of their business objectives, drivers, and needs
  • Coordinate with internal and external partners as needed to resolve the client's concerns
  • Act as the client advocate when communicating client needs and leading internal meetings focused on client solutions across Optum
  • Consult with clients to ensure they are utilizing Optum solutions to their greatest potential
  • Act as the liaison between key client contacts and Optum business leaders
  • Developing annual client plans and objectives
  • Ensure high satisfaction
  • Establish regular client planning sessions to review performance, client's business needs along with proposed solutions
  • Work with the renewal team to identify additional opportunities for the client
  • Initiate contract renewal discussions and ensure deadlines are met by working closely with the renewal team and sales.
  • Ensure detailed retention plans are created and review risk assessment
  • Ensure clients are receiving and maximizing value from the solutions they purchase
  • Engage Subject Matter Experts (SMEs) who drive process improvements focused on increasing client satisfaction, streamlining workflows and/or reducing internal expense
  • Identify and communicate existing solution enhancements and new solution needs by articulating the voice of the client and market
  • Serve as a mentor and coach for other team members
  • Developed long-term rapport with clients to cultivate loyalty
  • Focused on achieving highest level of expectations to meet client and company satisfaction
  • Provided timely and accurate delivery of client communications
  • Identified opportunities to up-sell additional services benefiting client
  • Collaborated with sales and other internal partners to provide accurate and effective implementations
  • Conducted highly productive meetings with customers, vendors and matrix partners
  • Supported sales team members to drive growth and development
  • Contacted customers via phone and email to explore connections, offer services and cement relationships.
  • Developed long-term rapport with clients to cultivate loyalty.
  • Focused on achieving highest level of expectations to meet client and company satisfaction.
  • Provided timely and accurate delivery of client communications.
  • Exhibited deep knowledge of products, establishing trust and respect.

Manager of Operations

Optum
Franklin, TN
11.2017 - 01.2021
  • Manage team production to ensure accurate and timely completion of tickets for lead/enhancements/projects
  • CA Agile Rally – facilitate, prioritize, and organize Rally tickets for multiple departments
  • Responsible for development of staff, maintenance of analytics, collaboration with internal/external matrix partners, and new innovations
  • Lead daily activities of staff which consists of Data Analyst, Exploratory Auditors, and Claim Auditors
  • Project Management included but not limited to: Client consolidations, specialized team projects, work with external vendors to yield potential for OEA
  • Financial analysis of analytics to ensure cases are properly forecasted
  • Maintain and manage several client specific processes as well as departmental processes
  • Reporting
  • Resolve complex problems by developing innovative solutions
  • Serve as key influencer of staff and matrix partners to ensure the success of the business
  • Facilitate team meetings and lead focus group meetings with matrix partners
  • Facilitate and/or lead client meetings
  • Budget financials and commissions for staff
  • Set targets for exploratory business analysts.
  • Trained employees on additional job positions to maintain coverage of roles.
  • Recruited and hired qualified candidates to fill open positions.
  • Assigned tasks to associates to fit skill levels and maximize team performance.
  • Evaluated and enhanced workflow to implement best practices, reduce costs and increase staff motivation and satisfaction.
  • Hired and onboarded team members to meet immediate and expected demand.
  • Engaged with existing and potential clients to gain insight into needs.

Healthcare Economics Consultant

Optum
Franklin, TN
06.2016 - 11.2017
  • Research potential overpayment scenarios through the use of internal and external data to identify overpaid claims used to build recurring algorithms
  • Identify and refine criteria to successfully build and enhance new and existing logic ensuring correct claim payment
  • Research and quickly identify patterns of claim payment abnormalities
  • Develop metrics to forecast profitability
  • Write business requirement documents for new trends and update existing documents as the logic is developed or changes over time
  • Maintain existing production algorithms to maximize performance while working directly with data analysts to test and implement changes
  • Facilitate new case kick off calls and training with operations and management
  • Project management
  • Breakdown complex problems into individual root causes
  • Serve as mentor to claims analyst
  • Review contractual and duplicate claims to identify overpayments
  • Utilize Network Pricer for MS/APR DRG review
  • Review and analyze Coordination of Benefits Supervisor
  • Supervise, monitor, track and direct day to day operations to staff
  • Provide expertise and/or general support to employees
  • Provide coaching and feedback to team members, including formal corrective action
  • Set priorities for the team to ensure task completion and performance goals are met, such as Quality, Adherence, Service Level
  • Conduct annual performance reviews for team members
  • Reporting
  • Interview potential job candidates
  • Serve as mentor to supporting roles
  • Resolve escalated issues
  • Coordinate and supervise the daily/weekly/monthly activities of a team members
  • Review inventory for financial opportunity
  • Identify trends and process improvement opportunities
  • Onboarding of new hires.
  • Served as primary liaison for clients, political stakeholders, providers and public policy associations, lobbyists and partners.

Supervisor of Operations

Optum
Franklin, TN
  • Built strong operational teams to meet process and production demands.
  • Motivated and evaluated personnel for performance improvement and goal achievement.
  • Addressed customer concerns with suitable solutions.
  • Notified customers of delinquent accounts with attempt to collect outstanding amounts.
  • Developed collection methods to achieve or exceed company financial goals.
  • Reviewed accounts to determine payment plan compliance.
  • Located and monitored overdue accounts using billing system to begin collections process.
  • Completed skip traces on customers failing respond to collection efforts.
  • Negotiated credit extensions to assist customers in paying overdue accounts.
  • Met demands of busy collections group by performing high volume of daily calls.
  • Located and notified customers of delinquent accounts by mail, telephone or personal visits to solicit payment.
  • Liaised with management to identify issues attributing to account delinquency and discuss solutions to bring in revenue.

Senior Account Manager

Optum
Franklin, TN
11.2013 - 05.2015
  • Build strong relationships with internal and external partners
  • Liaison to client for first level response
  • Investigate claim and/or customer service issues as identified and communicate resolution to customers
  • Reporting
  • Serve as mentor to supporting roles
  • Resolve escalated issues
  • Develop knowledge of current trends of medical payment and decoding to help identify recovery dollars
  • Balance open A/R
  • Review claim payments and offsets in regards to overpaid claims for health plans.
  • Developed productive relationships with business representatives and consulted closely to uncover needs and match available solutions.
  • Cultivated deep knowledge of customer businesses and relationship to company objectives.
  • Collaborated with customers to develop strategic business and account plans.

Process Coach

CIGNA CORPORATION, CIGNA CORPORATION
Chattanooga, Tennessee
12.2005 - 10.2013
  • Serve as process coach for manual Eligibility Account Specialists
  • Create process and procedures
  • Serve as adjunct facilitator to conduct trainings
  • Project specialist assisting to identify errors and trends for improvement Client Service Executive
  • Direct contact for all service related issues
  • Provided client support for service and benefits
  • Created benefit summaries
  • Handled complex issues
  • Ensure customer satisfaction by following up with customers frequently
  • Facilitated service calls to ensure overall client satisfaction
  • Conducted presentations to educate clients on products and services
  • Assisted with account implementation for new and/or renewing business
  • Provided customer service to beneficiaries, providers, employers, and co-workers via in and out bond calls.

Senior Client Service Executive

Cigna
Chattanooga, TN
12.2005 - 10.2013
  • Assisted in risk assessment and mitigation activities and promptly resolved service issues.
  • Identified and developed new business opportunities through client contracts.
  • Maintained client files, compiled reports and organized company resources.
  • Reported complex client issues, questions and needs to management.
  • Attended educational trainings and workshops for professional growth.
  • Attended to daily client service requests and provided support.
  • Made frequent calls and visits to build and strengthen client relationships.
  • Followed up on client leads, managed client applications and onboarded new clients.
  • Managed client complaints with high level of professionalism and competence.
  • Streamlined account application processes to improve operational productivity and offer quality service.
  • Administered employee insurance, pension and savings plans, working with insurance brokers and plan carriers.
  • Conducted randomized feedback surveys.

Senior Eligibility Account Specialist

Cigna
Chattanooga, TN
  • Served as the point of contact for eligibility for multiple clients
  • Implemented and maintained Regional and National Accounts
  • Educated clients on improving the overall claim quality which minimized margin of error
  • Thorough technical knowledge of manual and automated eligibility
  • Subject Matter Expert for Microsoft Excel formatting and submitting (SES)
  • Trained clients to use online portal, CIGNAACCESS.com
  • Created multiple reports to internal/external partners
  • Exceeded all metrics as it pertained to file processing accuracy, timeliness, and emergency updates.

Employer Services Consultant

Cigna
Chattanooga, TN
  • Manager for matrix partners and clients
  • Trained clients on online web tool
  • Process access to care eligibility updates
  • Worked on Defined Care Platform for Choice Fund Products.

Senior Customer Service Representative

Cigna
Chattanooga, TN
12.2005 - 10.2013
  • Served as Benefit Administrator and Customer Service Associate for managed care members
  • Researched and resolved Tier 2 medical and facility claims
  • Acted as an escalation point for COB claims
  • Received COB, Duplicate, and Medicare certification
  • Processed adjustments for medical claims
  • Served as a Rotational Technical Coach and Peer Coach to Customer Service Associates.

Education

Computer Science

TENNESSEE STATE UNIVERSITY
01.2003

Skills

  • Recruiting and hiring
  • Multidisciplinary team leadership
  • Consultative and relationship selling
  • Compelling leadership skills
  • Rapport and relationship building
  • Key account development
  • National account management
  • Salesforce Experience

Timeline

Regional Service Manager

Cigna
06.2023 - 01.2025

Client Manager

OPTUM
01.2021 - 03.2023

Manager of Operations

Optum
11.2017 - 01.2021

Healthcare Economics Consultant

Optum
06.2016 - 11.2017

Senior Account Manager

Optum
11.2013 - 05.2015

Process Coach

CIGNA CORPORATION, CIGNA CORPORATION
12.2005 - 10.2013

Senior Client Service Executive

Cigna
12.2005 - 10.2013

Senior Customer Service Representative

Cigna
12.2005 - 10.2013

Supervisor of Operations

Optum

Senior Eligibility Account Specialist

Cigna

Employer Services Consultant

Cigna

Computer Science

TENNESSEE STATE UNIVERSITY

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TRACI L. BAKER