Health Insurance Management

Annie Tran

**** ***** ******, #*** *** Angeles, CA 90034

*******@*****.*** 801-***-****

Professional Profile

Seasoned health and benefits compliance professional with strong

analytical, organizational and communication skills looking to leverage MBA

in a leadership role that will present opportunities to improve an

organization's operations. Demonstrated ability to work effectively and

efficiently in a fast-paced, highly demanding environment. Resourceful

problem solver with strong research and presentation skills. Team-player

who builds collaborative relationships and demonstrates responsible

leadership in a diverse environment. Proficient in implementing and

streamlining business processes.

Core Competencies

. Health Plan Operations

. Project Leadership

. Policy and Program Development

. Process Implementation

. Compliance Auditing

. Contract Negotiation and Management

. Regulatory Compliance

. Training and Communications

. Internal Affairs

. Statutory Research

. Incident Investigation

. Health Insurance Products

. Insurance Certifications

Professional Experience

Marsh & McLennan Companies, Inc., Los Angeles, CA

June 2006 to present

Mercer

Senior Associate

Developed national monitoring programs and tools to measure compliance with

company standards and regulatory requirements, improving year-to-year

compliance results in all 47 Mercer offices nationwide.

. Performed audits of Mercer offices (47 offices and 2,200 employees) to

ensure adherence to internal business standards and effective controls

are in place; presented observations and recommendations to local

business leadership.

. Supervised and trained on-site audit teams of 2-4 members to ensure

audits are completed accurately, timely and in accordance with company

standards.

. Collaborated with members of the national compliance team and local

compliance managers to implement process improvements and make certain

processes are leveraged across the business.

. Collaborated with local leadership teams in developing action plans to

improve processes and minimize deficiencies.

. Identified high risk areas requiring formalized business processes by

developing and implementing various risk management measures.

. Evaluated modifications of compliance programs to increase business

efficiency and compliance effectiveness.

. Conducted investigations of 1000+ employees for non-compliant acts and

identify incidents resulting in errors and omissions exposure.

. Managed multiple implementation projects and introduced new processes and

standards to colleagues (most recent project include the implementation

of HITECH changes to HIPAA Privacy rules).

. Developed and delivered bi-monthly compliance training and communication

initiatives.

. Introduced, implemented and oversaw compliance programs for 3 lines of

business.

. Wrote, reviewed, and negotiated contracts with clients, vendors and other

third parties for adherence with regulations and company policies; review

and negotiate an average of 25 contracts per month.

. Created a contract management database to track 200+ contracts to improve

workflow and increase efficiency.

Intermountain Healthcare, Salt Lake City, UT

August 2001 to June 2006

SelectHealth

Senior Contract Analyst - April 2004 to June 2006

Served as a lobbyist on behalf of the company and the Utah Health Insurance

Association during 2 Utah state legislative sessions; lobbying efforts

included educating and negotiating with legislators on costly health

insurance legislation. Successfully managed coordination of benefits

settlements and duplication of payment issues by reducing $500,000 in claim

expenses between 2002 and 2004.

. Supervised 4 colleagues and managed activities within the

Compliance/Contracts Department.

. Collaborated with the operations, enrollment, marketing, underwriting,

accounting, claims processing and IT departments to implement policies

and procedures resulting from various laws and regulations while ensuring

health plan operations are effectively integrated.

. Drafted contract provisions for new and existing insurance products,

ensuring contracts are compliant with all applicable laws and accurately

reflect company policy.

. Conducted training for internal employees and external health insurance

agents on federal and state regulations, and provided procedures to

successfully implement compliance programs for employer groups.

. Served as a point person of the Compliance/Contracts department in

various internal committees including Research and Implementation,

Eligibility Review, New Product Implementation, and Special Investigation

Fraud Unit.

. Represented the company in external committees including the Utah Health

Insurance Association and the Utah Insurance Commissioner's Task Force

for Reducing Utah Uninsureds.

Contract Analyst - August 2002 to April 2004

Developed compliance procedures for 700 employees that accurately reflect

the administration of company contracts and state and federal regulations.

. Analyzed, implemented, and monitored federal and state health insurance

laws (including COBRA and HIPAA).

. Conducted training for internal departments on the requirements of

federal and state laws.

. Created a process to manage product and benefit changes from year to

year.

. Assisted the Director of Government Relations in lobbying activities

during the Utah state legislative session.

. Preformed product and member materials filing for state insurance

departments and ensured that all materials submitted are in compliance

with all federal and state laws.

. Reviewed all literature prior to distribution to ensure compliance with

state and federal laws.

Underwriting Analyst - August 2001 to August 2002

. Performed underwriting, and risk analysis for employer groups between 51

and 2500 employees by determining premium levels suitable for risks being

covered.

. Audited employer groups to ensure adherence to underwriting guidelines,

including contribution and participation requirements.

. Designed benefits to reduce potential adverse selection and utilization

abuse.

. Negotiated with internal account coordinators and external benefit

consultants on premium rates, benefit factors, and benefit designs.

Education

Graziadio School of Business and Management, Pepperdine University, Malibu,

CA

Master of Business Administration, August 2009. GPA: 3.84/4.00

John M. Olin School of Business, Washington University, St. Louis, MO

Bachelor of Science in Business Administration (double-major in Finance &

Marketing), May 2001

Professional Designations, Affiliations & Licenses

. Association of Health Insurance Plans Designations: Health Insurance

Associate (HIA), Managed Health Professional (MHP), and HIPAA Associate

(HIPAAA)

. Life, Accident & Health Producer License

. Beta Gamma Sigma Honor Society

. National Association of Women MBAs

Skills

. MS Excel, MS Power Point, MS Word

. Fluent in Cantonese (spoken)

. Conversational Mandarin

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