Project Manager Customer Service

Raebeth L. Boor

**** * ******* ** ***. K Appleton, WI 54915 920-***-**** ***********@*******.***

Objective _______________________________________________________________________________

Consultant role allowing for an opportunity to demonstrate innovative business perspective blended with a strong

communication skill set with a focus on quality, process improvements, customer needs and business initiatives.

Profile _________________________________________________________________________________

A results driven, business professional, with proven abilities in process improvement and consultant responsibilities.

Over nine years experience in the health insurance industry, with exposure to diverse segments including group,

individual, government health plans, specialty products, small and large group, fully insured and self funded

business. Background includes claims adjudication, customer service, process improvement, consultant

responsibilities, human capital management and system development. Familiarity with all employer benefits

business processes including eligibility & enrollment, premium billing, provider services / network contracting, life

insurance, disability income, and underwriting. Strong ability to communicate with a diverse group of individuals

while maintaining the integrity of the individual department needs while focusing on the business goal.

Skills Summary _________________________________________________________________________

1. Six Sigma Yellow Belt 5. Operation 8. Insurance Regulation &

Certification requirements for Compliance

2. Claims and Compliance budgets, inventory 9. Virtual Meeting &

Regulatory Requirements management and Training Facilitation

3. Productivity/Process Human Capital 10. Professional Presentations

Improvement 6. Quality Reporting 11. Customer Service Skills

4. Meeting Facilitation with and Improvement 12. Strong technical ability

large and small groups 7. Microsoft Office

Suites, Corporate

reporting tools

Professional Experience __________________________________________________________________

Frontline Leader- Grievance and appeals (2007-Current)

1. Review Grievance & Appeal processes and systems for improvements and/or policy changes. Communicate

business needs with internal business partners including Management, Process Organization, IT and

Compliance.

2. Thorough understanding of Humana systems and workflow process for Grievance & Appeals. Also ability

to consider, review and communicate impact of department changes on other business areas.

3. Utilize appeal reporting to identify trends, process improvements and educational opportunities for internal

and external customers.

4. Communicate with associates to understand system and process impacts. Utilized tools and resources to

review requests and work for resolutions that meet business and associate needs.

5. Developed creative themes and associate activities for team and department meetings.

6. Assisted Corporate Initiatives in specialty training for associate development. Created virtual training and

motivational tools.

Raebeth L. Boor

7. Educated associates on corporate value propositions, understanding corporate financial impacts and

applying corporate vision to everyday roles.

8. Utilized production and quality metric reports to identify individual and team trends. Assisted in creating

goals with individuals and team to improve metrics.

9. Ability to learn and adapt to consistently evolving industry and business initiatives.

Business Consultant Examples:

Expedited Appeal Process Improvement Led team of associates from several service centers in review,

•

improvement and implementation of expedited appeal process to include additional data reporting

capabilities with business systems. Utilized process flows, data results and process updates to guide

leadership and associates on process implementation. Included consistent follow up, data analysis and

process review.

System Enhancements Represented Grievance and Appeals in testing for system enhancements. Tested

•

work items based on Project Managers requests. Communicated system issues, errors and possible

resolutions with Project Manager, Leadership and associates.

Corporate Database Migration to new location Represented Grievance and Appeals in corporate system

•

migration to new location. Attended scheduled process updates with IT, Leadership and rework areas.

Tested work items to determine migration effectiveness. Communicated system issues, errors and possible

resolutions with Project Manager, Leadership and associates.

Provider Portal Medical Record Process Represented Grievance and Appeals in review of process

•

workflows to determine potential process improvements in order to meet compliance and regulatory

requirements with minimal impact to production.

Employment History _____________________________________________________________________

HUMANA INSURANCE COMPANY – Green Bay, WI

Grievance & Appeals Frontline Leader, 2007 Present Grievance &

Appeals Lead 2006 2007 Grievance & Appeals Specialist

2005 2006 (Please note employment gap is due to education)

Self funded Benefit Analyst 1996 1999 Self funded

Investigation Analyst 1995 1996

Education ______________________________________________________________________________

UNIVERSITY OF WISCONSIN PLATTEVILLE

Bachelor of Science Degree Communications, 2005

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