Tricia Gress

• Launched new department in under 90 days, resulting in a 15% profitability increase in the first year.
• Installed 4 industry leading reinsurance carriers and achieved revenue gains over 15 million in year two.
• Formed strategic alliances with PBM's, EDI Clearinghouses, and HRIS to optimize service levels and provisions.
• Managed staff of 70+ employees and trained cross-functional teams in Implementation, Client Relations, System Configuration, Eligibility, Quality Assurance, Billing, Claims, Reinsurance and Renewals.
• Identified process optimization opportunities through data analytics.
• Created tailored career assessment paths for employees, resulting in a 15% increase in promotions within the department.
• Managed TPA administration of self-funded and fully insured benefits, including medical, dental, vision, life, disability, FSA, HSA, HRA, COBRA as well as supplemental health, worksite and stop loss products.
• Qlik Sense SQL report and dashboard development.
• Configured and integrated software.
• Key presenter in RFP interviews.

• Successfully represented client in all TPA interactions.
• Ensured seamless execution of client implementation for both new and existing customers.
• Achieved high levels of client satisfaction by providing focused support from point of sale to continued administrative assistance, consistently delivering on time and within budget.
• Implemented HRIS system configuration to facilitate the execution of employee benefits open enrollment processes and new hire benefit offerings. Utilized HR systems like ADP, BenefitFocus, Paycom, PlanSource for seamless integration.
• Managed cross functional teams supporting back room HR benefits management, employee contact centers, HR account management, renewal vendor negotiations and data analytic configuration, testing and delivery.
• Ensured comprehensive documentation of all services offered to encompass scope of services manual.
• Guided and motivated staff through client feedback sessions, enhancing overall performance.
• Maintained quality control by conducting detailed review and approval of implementation schedules.

• Successfully operated a newly introduced commercial health insurance division.
• Collaborated with President to develop long-term growth and development plans for the division.
• Established productive relationships with key internal stakeholders including HR, IT, Finance as well as Sales and Marketing divisions.
• Recruited and developed diverse teams for administrative services spanning Enrollment, Billing, Customer Service, Claims, and Information Technology.
• Developed and implemented budgets for operational departments, ensuring efficient allocation of resources.
• Took a lead role in developing custom program specifications for software implementation, maintained compliance with ERISA regulatory requirements, and oversaw screen design layout.
• Consulted on process efficiencies for existing Union Division business, reducing costs.

VP, Benefit Healthcare Operations (2011-2014)

• Implemented targeted re-training QA program, resulting in 10% increase in quality control among claims adjusters.
• Increased claims productivity by 21% through implementation of a streamlined coding system for benefit plans.
• Launched Loomis University's online employee training program.
• Negotiated more favorable terms with provider, resulting in a $1 million cost reduction over 2 years.
• Generated $1.5 million in cost savings by restructuring division within the initial year.
• Implemented automated systems for re-insurance reporting, resulting in a 30% reduction in departmental expenses.
• Increased customer happiness through the utilization of a web-based call quality assessment platform.
• Enhanced staff motivation by 25% via an online employee recognition program.
• Achieved a 8% increase in EDI auto pay productivity through the development and implementation of an automated provider contracting system.

Assistant VP, Business Development (2010-2011)

• Implemented changes to the online enrollment portal that led to a significant 15% sales growth within the initial year.
• Achieved a $600,000 increase in profits by introducing new minimum monthly fees.
• Accelerated claims processing through the creation of a comprehensive universal table for EOB messaging.
• Reduced customer service calls by 3% by implementing an automated EOB vendor communication system.
• Achieved a 5% decrease in daily rise of EDI automated claims through adjustments to ICD-9 codes.
• Achieved a 4% reduction in telephone calls through the implementation of provider fax back protocols and web-based go green initiatives.

Assistant VP, Claims Administration (2005-2010)

• Reduced training costs by 50% through the development of an innovative claim classification program.
• Executed deployment of updated Reinsurance filing system.
• Developed front-end automated provider contract program to enhance EDI auto claims throughput
• Designed and implemented an efficient batch work distribution system to automate the assignment of claims for adjudication.

Operations Manager (2002-2006)

• Migrated office IT system to AS/400 claims software.
• Conducted in-person visits resulting in a 98% client retention rate during acquisition.
• Modified work flow protocols resulting in a 60% increase in productivity for the provider and data control department.

Business Analyst-Systematic Plan Design Specialist (1999-2002)

• Key resource for implementing AS/400 system upgrade.
• Led the acquisition conversion efforts for a portfolio of over 175 group health and vision plans.
• Systematically coded benefit plans for claims adjudication payments.