PEGGY DECKER
**** ***** **** **. #** Cincinnati, Ohio 45247
T: 513-***-**** / ***********@*******.***
qualifications
EXPERIENCED OPERATIONS MANAGER
Twenty four years of leadership experience with high-volume
claims and call centers and financial management roles.
Exceptional level of professionalism.
Strong and inspirational leader with a talent for motivating and
recruiting exceptional talent. Passionate about associate
engagement and customer service and tenacious in the pursuit of
"Perfect Service". Equally adept in strategic planning and
process improvement execution. History of quantifiable success.
AREAS OF EXPERTISE
? Team leadership ? Project Management
? Analytical
? Customer Service ? Budget Management
? Organization
? Six Sigma ? Recruiting
? Process Improvement
? Lean Sigma ? Relationship Building
? Microsoft Applications
PROFESSIONAL EXPERIENCE
Manager of Operations 2007-2010
Humana, Cincinnati, Ohio
Recruited to execute start up of pharmacy mail-order and drug
authorization call centers utilizing Avaya phone systems.
Recruited a team of 12 exceptional supervisors and 250 associates
and created efficient processes that ensured "Perfect Service"
for customers.
Directed and managed an incoming call center doing over 8M
scripts by phone per year and 4,000 drug authorizations
Administered Humana's Perfect Service Vision and Model within
department
Responsible for building and maintaining positive morale of the
team
Partnered with Workforce Management to ensure appropriate
staffing
Analyzed all processes and identified process enhancements using
Six Sigma and Lean Sigma tools.
Claims/Correspondence/Grievance 2003-2006
and Appeals Manager
Responsible for developing frontline staff and coaching and
mentoring supervisors.
Managed all aspects of the Grievance &Appeals and
Correspondence/Claims Rework units for all platforms serviced by
the Cincinnati Service Center
Developed strong relationships between service centers to ensure
consistency in processes and excellent customer service
Developed Tracking and trending model for all operational metrics
as it applies to Grievance &Appeals, claims and correspondence
Performed route cause analysis and develop action plans to
correct claims operational issues
Administered process for external review of appeals
Worked directly with providers and the contracting area to
troubleshoot claims issues
Continuously monitoring processes and procedures to ensure
maximum production and quality
Managed platform migration strategy as it relates to
Correspondence and Claims rework units
Responsible for staffing models and budgets
Headed oversight and completion of the ChoiceCare platform
shutdown
PEGGY DECKER RESUME - PAGE 2
PROFESSIONAL EXPERIENCE - Continuation
Market Relations Manager 2002-2003
Developed relationships between market offices and service center
to ensure customer and member satisfaction
Integrate and improve processes within corporate, market office
and service center
Drove excellent service delivery to complex customers
Managed cross -functional teams including Humana's service center
realignment
Provider Reimbursement Manager 1999-2002
and Manager of Financial
Recovery and Claims
Managed all aspects of claims review and payments and a staff of
65
Headed the Provider reimbursement area which included development
of fee schedules including capitation rates for hospitals and
provider offices
Coordinated efforts with the Network area to contract with
hospitals and provider offices
Maintained all data used to develop fee schedules
Worked directly with IT to ensure proper loading of all fee
schedules, DRG multipliers and weights and all current CPT codes,
ICD9 and HCPCs
Established financial recovery area which audited and collected
overpayments made to providers
Senior Reimbursement Analyst
1990-1999
Helped develop fee schedules that were used in negotiations of
hospital and physician contracting
Ensured all rates were loaded correctly
Junior Accountant
1985-1990
Responsible for accounts payable and receivables
Managed payroll for Cincinnati based associates
Education
Pursuing Degree in Business Management and Finance at Mt. St.
Joseph College