RICHARD POOLE

Bethel Park, PA *****

412-***-****

ad5ant@r.postjobfree.com

With over a decade of experience in healthcare, audit, and compliance, I am a versatile professional known for thriving in fast-paced environments. Equipped with advanced training in complex problem-solving techniques, I consistently deliver superior analytical insights. My excellent verbal and written communication skills foster seamless interaction with colleagues and stakeholders. Drawing from a proven track record of success, I am well- prepared to impact any team or project positively. WORK EXPERIENCE

Data Measurement and Analytics Lead Analyst

06/2020 to Present

New York Life

Pittsburgh, PA

Conduct comprehensive quality reviews of internal documentation and systems at New York Life, ensuring the accuracy of company deliverables.

Offer guidance and coaching to team members and business stakeholders, fostering a collaborative environment focused on continuous improvement.

Develop and maintain audit results in a format easily understood by business stakeholders, facilitating actionable insights and decision-making.

Successfully managed multiple priority deliverables in a fast-paced environment, consistently meeting deadlines for results and analysis reports.

Analyze processes, research compliance guidelines, and interpret data to ensure completeness and accuracy of deliverables while identifying and communicating defects or errors for resolution. Quality Review Audit Analyst

06/2018 to 06/2020

Cigna Group Operations

Pittsburgh, PA

Utilized comprehensive knowledge of claim processing, call handling, and auditing procedures to conduct audits effectively, ensuring compliance and accuracy. Collaborated closely with Cigna Group Operations partners to troubleshoot system issues and review call processes, facilitating smoother operations and improved performance. Conducted thorough audits of calls, adhering to internal guidelines and evaluating accuracy against established standards.

Demonstrated accountability for auditing deliverables in alignment with compliance policies, contractual obligations, and standard operating procedures, maintaining a high level of quality assurance. Proactively identified areas for improvement and developed tailored training programs to address errors or emerging trends, fostering continuous professional development and enhancing overall performance. Consumer Advocacy Specialist

06/2013 to 06/2018

Cigna Group Operations

Pittsburgh, PA

Demonstrated expertise in navigating and understanding complex state and federal laws governing various products and policies, ensuring compliance, and mitigating legal risks. Crafted diplomatic and professional responses to written complaints and inquiries from state and federal law enforcement agencies, fostering positive relationships and resolving issues effectively. Contributed to developing customized workflows and procedures for clients, ensuring alignment with policies and agreements, and enhancing operational efficiency. Spearheaded educational initiatives within the claim organization, facilitating understanding of client and customer trends, metrics, and industry insights through regular management meetings and fostering informed decision-making.

Drove change and innovation by influencing stakeholders across departments to implement appropriate actions and initiatives to achieve timely and effective results while continuously evaluating and improving business processes in collaboration with internal and external partners. Group Claims Analyst

03/2008 to 06/2013

Cigna Group Operations

Pittsburgh, PA

As a project manager, I calculated and distributed potential work-related offsets for team accounts, ensuring accurate allocation and compliance with contractual provisions. Managed case assignments to associates, oversaw project execution, monitored progress, and provided regular updates to managers, facilitating streamlined workflow and effective task delegation. Demonstrated proficiency in understanding and interpreting diverse contractual provisions, enabling informed decision-making and adherence to contractual obligations. Thrived in a collaborative team environment, working closely with colleagues to achieve quarterly goals, fostering synergy and teamwork to drive collective success. Established effective communication channels with providers to convey policy guidelines, enhancing understanding and compliance with organizational protocols. SKILLS

MS Office Word, Excel, Forms, PowerPoint - 10+ years Power BI - 6 years

EDUCATION

Slippery Rock University

Bachelor's

Secondary Education

Slippery Rock, PA

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