Audit and Compliance Professional

Diana DeFelipe, JD, CPA, MBA, CFE

Executive Summary

Leader in the areas of compliance, auditing, and strategic planning. Collaborated with business partners from different industries ranging from healthcare to software development, telecommunications, and manufacturing. Managed teams in Compliance, and other engagements to achieve successful outcomes. Fluent in Spanish and skilled in working with diverse, international teams. Certified Fraud Examiner.

Areas of Expertise

Regulatory Compliance

Internal Controls

Client Relations

Communications

Policies & Procedures

Sarbanes Oxley (SOX)

Accomplishments

Created a tracking system to ensure that all regulatory reports were completed and submitted to the agencies on time

Successfully managed a team of 5 who completed the Quality Analysis and review of documents for the bid submissions for 95 health plans during the CY2015 Medicare submission process.

Supported the start-up of three Medicare-Medicaid Plans, including oversight of the Readiness Review and drafting of required member facing documents.

Ensured the work of the Actuary and Finance teams for the bid submissions was complete and accurate.

Recommended changes for monitoring system access to ensure that unauthorized persons could not open files with Personal Health Information included, causing the company to incur high penalties and its reputation to suffer.

ERP Implementation: created Cost Centers and Work Centers in the Axiom financial system to allow better financial reporting and financial analysis of results.

Streamlined the reconciliation processes Acting Assistant Controller for a steel manufacturer, enabling the division to complete and submit all reconciliations to the Corporate office on time for the first time since their acquisition in 2008.

Uncovered over $1.3 billion in lost revenue for a client in the banking industry while analyzing and reconciling over 12,000 open items totaling $775.6M found in a federal clearing account.

Professional Experience

Anthem, Inc. 2012 to 2017

Leading provider of health insurance, with operations in 14 states, as well as a leading governmental insurer

Health Plan Chief Compliance Officer/Compliance Director: collaborate with the operational areas and Enterprise teams to ensure that the Health Plan complies with the Three Way Contract and regulatory requirements for the successful implementation of the Fully Integrated Duals Application (FIDA) Plan. Manage the day-to-day operational compliance requirements for the health plan, including interactions with state and federal regulators. Maintain good compliance standards during the exit from the market.

Regulatory Compliance Manager: support several functional areas of the Medicare Advantage business to ensure that processes meet regulatory requirements

Senior Internal Auditor: operate the Internal Audit function for the Federal Employee Program division, reviewing controls and providing consulting services for 17 departments.

Midwest Credit Union 2013 to 2014

Financial institution serving the employees of WellPoint, Inc.

Board Member: set strategy for the organization, review operations, managed long-term goals, and assisted in the successful merger with another credit union

Consulting in Compliance and Finance

Served clients in various industries, including healthcare, manufacturing, and insurance. The companies I utilized to locate areas where I could be of assistance included:

Resources Global Professionals 2011 to 2012

Financial consulting firm with offices around the world

Finance and Accounting Consultant: provided reconciliation services for a major local government agency and acted as the Accounting Manager while the position was vacant

Experis 2006 to 2012

Financial consulting firm with offices around the world

Risk Advisory Services Consultant: performed both SOX and internal audits, analytical analysis, account reconciliation activities, and other financial consultative services for clients in many industries, including banking, insurance, retail, manufacturing, healthcare and automotive.

D D Consulting 2004 to 2012

Independent consulting company working with search firms such as Robert Half, KForce and others, in positions such as:

Interim Assistant Controller: managed the monthly close process and financial analysis of operating results

Education

University of Cincinnati, JD

Xavier University, MBA, Multinational Business

University of Cincinnati, BBA, Accounting and Marketing

Certifications and Memberships

Certified Fraud Examiner, ACFE

Certified Public Accountant, OH

Admitted to Law Practice, OH

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