Compliance & Operations Professional with Training Experience
Resume:
Julie Gorton
Chippewa Falls, WI 54729
***********@*****.***
T.J. MAXX August 2014 to May 2020
Part-time Sales Associate
Operations and Sales support included:
Creating store presentations, ideas and concepts to successfully promote store merchandise.
Building strong client base through effective sales and promotional marketing.
Implementing store policies.
Overseeing daily store operations.
CHIPPEWA VALLEY TECHNICAL COLLEGE, EAU CLAIRE, WI August 2014 to December 2014
Adjunct Communications Instructor
Instruction focuses upon developing speaking, verbal and nonverbal communication, and listening skills through individual presentations, group activities, and other projects.
UNITEDHEALTHCARE, MINNETONKA, MN November 2012 to July 2013
Medicare & Retirement Business Detection Mgr.
Medicare & Retirement Compliance Manager manages a team responsible for monitoring changes with internal laws and regulations to ensure compliance with State and Federal guidelines, per CMS requirements. Responsibilities include establishing, mandating and implementing standard policies, procedures and best practices across the company to promote compliance with Centers for Medicare & Medicaid Services applicable laws and contractual obligations. Responsible for conducting state-specific legal research and monitoring changes in requirements to mitigate risks and achieve compliance. Also work with Maximus, AARP, employer groups, providers and other outside vendors to ensure CMS requirements are followed in areas such as Community & State, Employer and Individual, Medicare areas, etc.
Other responsibilities included:
Performing as project manager in all aspects of the Government Program Integrity compliance function.
Assisting with compliance for national based and state specific fraud, waste and abuse initiatives.
Developing and leading training and education on compliance related topics.
Collaborating with other compliance professionals cross-functionally to ensure regulatory and contractual requirements are met.
Managing a compliance function that monitors compliance with state, local and federal legislation which meets the best business practice standards in health care.
Investigating identified compliance matters, including corrective action and mitigation.
Developing and implementing policies, procedures, structures and processes to meet regulatory and contractual requirements.
Establishing and maintaining a high profile within Government Program Integrity pertaining to compliance, regulatory compliance and ethics.
Responding to inquiries from state and federal regulators
UPSHER-SMITH LABORATORIES, INC. February 2012 to September 2012
Pharmaceutical Marketing Manager Consultant
Leading efforts in meeting specific Early Stage Commercialization (ESC) initiatives for various pharmaceuticals through clear positioning strategies, actionable and impactful tactics and comprehensive implementation plans, while working closely with external and internal organizations.
Responsibilities included:
Supporting best-in-class launches in emerging markets and continually supporting all pharmaceutical partners throughout the process.
Ensuring full compliance with internal policies and guidelines, as well as meeting legal and regulatory requirements while engaging agencies and Healthcare Professionals.
Developing, managing and executing email and mobile text messaging for pharmaceutical brand campaigns and ecommerce.
Establishing marketing channel benchmarks, summarizing key insights, and recommending actions to improve performance of pharmaceutical marketing programs.
Supporting broader business and portfolio strategies.
Adhering to annual pharmaceutical marketing channel budget.
UNITEDHEALTHCARE, MINNETONKA, MN September 2011 to January 2012
Medicare & Retirement Group Operational Readiness Consultant
Provided oversight and guidance to Group Retirement Operational Teams to ensure readiness for the Centers for Medicare and Medicaid’s (CMS) mandated Annual Open Enrollment (AEP) period.
Responsibilities included:
Collaborating with Medicare & Retirement Operation areas to review, analyze and oversee policies and procedures to ensure compliance with Centers for Medicare & Medicaid requirements.
Consulting and coordinating with Medicare Regulatory Reporting Team on regulatory requirements.
Taking point on special projects related to the operations and administration, for improvement initiatives driven by business needs (e.g., AEP Readiness, speed to market, member impact reduction, etc.).
Working with internal business SMEs to gather business requirements or reporting requirements.
Defining and documenting business processes and system processes, as they related to the problems being solved.
Supporting business partners and end users through issue management and prioritization, resolution, verification, training and communication.
Recommending and implementing documentation; evaluating and maintaining policies, procedures and controls.
Monitoring of day-to-day operations and processes.
Facilitating change management to help empower employees and to coach the operations organization to think in terms of continuous improvement.
UNITEDHEALTHCARE, MINNETONKA, MN April 2011 to September 2011
Medicare & Retirement Solutions Proposal Writer Consultant
Provided business-winning responses for the Medicare & Retirement Solutions sales team to increase company brand and profitability. In this role, I developed, wrote and managed the Requests for Proposals for large employer groups with retiree populations that were impacted by Medicare. Wrote and marketed services such as Medicare Supplements, Medicare Advantage plans, prescription solutions, Senior Supplements, and AARP Medicare Supplemental Insurance plans.
Responsibilities included:
Conveying complex thoughts, both written and oral, in clear, concise ways that were tailored to the 55+ segment.
Effectively understanding Response for Proposal (RFP) questions and searching the core databases to find accurate and complete responses.
Researching customers’ needs (through Web sites and other sources) and working with sales teams to develop meaningful and thoughtful questions to extract the necessary case information.
Understanding network and financial information and bringing those elements into the case writing process.
Working in a highly matrixed environment and collaborating with sister proposal units to reflect one core value story and to integrate internal processes.
Maintaining and enhancing business skills, including the understanding of health care industries, managed care trends, healthcare reform, etc. and participating in all relevant training opportunities to improve and expand my current skills.
Completing all project-related work in a timely, productive manner and meeting all case deadlines.
THE SHOP AT THE MARSH September 2010 – April 2011
Sales Associate
Operations and Sales support included:
Creating store presentations, ideas and concepts to successfully promote store merchandise.
Building strong client base through effective sales and promotional marketing.
Implementing store policies.
Overseeing daily store operations.
SECUREPATH BY TRANSAMERICA, ST. PAUL, MN July 2009 – October 2009
Consultant Marketing Manager for Credit Unions & Third Parties
Hired as a Consultant Marketing Manager to formulate, plan and execute new marketing plans for the Credit Union segment, as well as the Third Party segment. This included the execution of exhibition fairs, product launches, brand partnering, media advertising, etc.
Established a periodical review for marketing activities, assessed and evaluated results and gave feedback to higher management team to determine next course of actions.
UNITEDHEALTHCARE, MINNETONKA, MN March 2009 –July 2009
Small Business Outbound Marketing Specialist Consultant
Hired as a Consultant to make outbound calls to the Small Business Broker Community to recruit, provide information, follow-up and generate new leads. Other responsibilities included participating in various outbound and inbound telephone outreach projects as assigned and assisting in the appointment process.
AFFILIATED BENEFIT GROUP, MINNETONKA, MN September 2008 – October 2008
Office Manager Consultant for Healthcare Broker
Hired as a Consultant to maintain broker administrative duties with Blue Cross Blue Shield of Minnesota, UnitedHealth Group, PreferredOne, HealthPartners, especially during small group renewal periods. Key responsibilities included identifying, examining and renewing contracts, small health group business opportunities with President and Owner of brokerage firm.
OPTUMHEALTH, GOLDEN VALLEY, MN January 2008 – July 2008
Part D Project Manager Consultant for Large Group Retirees
Hired as a Consultant to market new and varied prescription solutions to the Medicare segment, as well as various other segments of the 55+ population. This included working with Legal and Regulatory Affairs, Large Employer Groups, CMS, AARP, various sales departments, and Account Management Teams. One of the main goals of the Medicare Part D marketing, was to keep retirees’ aware of their health situations and helping them to join wellness programs to keep utilization down, so that costs wouldn't go up for these employer groups. Some of my responsibilities were to:
Ensure successful implementation of market strategies leading to gross profit market improvements within the Medicare Part D segments by 30%.
Spearhead and successfully close all Medicare Part D marketing initiatives, online services, project management and account management, to increase the Medicare Part D program by 15%, through new employer groups.
Successful management over 700 Medicare Part D projects for the Public Segment and Large Group Employers Segment, leading to Medicare Part D marketing services that saved UnitedHealth Group 30% in overall Medicare Part D advertising, marketing and online services. Increased the Medicare Part D membership by 20%.
OVATIONS, MINNETONKA, MN June 2007 – January 2008
Part D Marketing Manager Consultant for Large Group Retirees
Managed marketing campaigns for Medicare Part D initiatives and helped to create all Medicare Part D communication materials for all Employer Groups, making sure that all formularies, pricing and coverage for each group was compatible with CMS data. Worked with Legal and Regulatory Affairs teams to insure correct information was disseminated to all clients.
Created Medicare and Medicaid market research data to find appropriate needs assessments and to determine future cost estimates. This included research on prescription solutions, products, market segments, finances and competitive analyses.
Successfully marketed to and managed over 100 Large Employer Groups, for prescription solutions that led to an increase of overall Large Employer Group prescription solutions by 30%.
Created marketing initiatives for Specialty pharmaceuticals by implementing such things as pharmacy partnerships and specialty pharmacy delivery; care management to ensure appropriate treatment initiation and continuation, along with utilization analyses.
DELUXE CORPORATION, SHOREVIEW, MN January 2007 – June 2007
Category Manager Consultant
As a Consultant, helped to create and develop new products and services for financial institutions and their clients; products and services such as identity theft prevention, online seminars for personal financial health, and services to help the Sales Divisions sell more products and services to financial institutions and increase revenue by 32%.
THRIVENT FINANCIAL, MINNEAPOLIS, MN June 2006 – January 2007
Senior Marketing Strategist Consultant for
Teleservices, Seminars and Events
Collaborated with outside agencies to develop new financial seminars, particularly for the senior marketplace. Managed the teleservices division to promote new financial products and services to various customer segments. Was the lead in supporting all departments with the creation, production and marketing of all financial seminars and events, ensuring that the Sales Field was introduced to all new products and services at various national venues and through sales training programs.
OPTUMHEALTH AND UNITEDHEALTH CARE, EDINA, MN June 2005 – June 2006
Marketing Services Proposal Writer Consultant,
Network Provider Consultant
Developed, wrote and managed the Requests for Proposals for large corporate and government employers. Created profitable bids for new employer group contracts, as well as new initiatives for healthcare management. Wrote and marketed services regarding specialty pharmaceuticals, including the introduction of utilizing a single source for specialty pharmacy products which would help a consumer simplify the cost of the drugs and standardize the billing for the healthcare insurance system. Almost any large group proposal that I ever wrote, included various sections on Specialty Pharmaceuticals.
Worked as a part of the National Provider Network Team within the managed care division. Initial responsibilities included provider negotiations, policy implementation and the establishment of key market performance metrics. Activities included: oversight and growth of the overall provider network (50 states and approximately 12,000 contracts), implementation of strategic initiatives, achieve and maintain gross profit targets, assess market conditions in anticipation of new business, develop and deploy strategic market plans, and communicate with senior management team to enhance decision making efforts. Key contributions included:
Successful implementation of market strategies leading to gross profit market improvements within “at risk” territories by an average of 50%.
Spearheading and closing profitable negotiations and analytics of three national provider contracts with revenues in excess of $15,000,000 respectively.
Developing formalized procedures and provider contracts to comply with URAC requirements and led procedural implementation throughout organization.
Consistently maintaining and delivering a sufficient and profitable national network of healthcare providers that has rendered services to over 1.5 million patients.
SODEXHO USA CAMPUS DINING SERVICES August 2002 – June 2005
University of Wisconsin – Eau Claire
Director of Marketing
Director of marketing for 35 campus food service establishments; utilizing online marketing, events, promotions and direct marketing to grow food establishment revenue. Was responsible for working with vendors such as Taco Bell, Coca-Cola, Starbucks, etc. to promoted and enhance the dining experience for on-campus and off-campus segments.
Successfully created new dining concepts and dining marketing programs to increase food services profits by 16%.
WOUND MANAGEMENT CORPORATION, ST. PETERSBURG, FL April 2001 – July 2002
Analyzed, approved and authorized assigned claims and determined benefits due pursuant to a disability plan.
Determined benefits due, made timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
Medically managed disability claims ensuring compliance with duration control guidelines and plan provisions.
Communicated clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence.
Informed claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system.
THOMSON WEST GROUP May 1997 – March 2001
Media Buyer, Direct Marketer for 26 States,
Medium Law Firm Segment Marketer,
Manager of Technology Product Development
Primary lead with IT and business partners driving key needs on online/software product development.
Responsible for Business Vision Documents, Business Requirements, User Acceptance Testing and final deployment of development projects.
Analyzed complex business processes and files to understand the relationships, functionality and dependencies between business groups.
Analyzed data, identified best practices and facilitated the design and implementation of improvement activities to ensure tools and processes ran effectively.
Supported business partners and end users through issue management and prioritization, resolution, verification, training and communication within the development of legal software and products.
Managed marketing product development communications budget of $1.2M for Thomson West Group’s ($1 billion online information and technology corporation) online technology product releases and enhancements through internal and external initiatives, company seminars, white papers, and product launches for numerous industries and services. Communications also included internal employee announcements, development of customers and peers through seminars, the building of media relations, purchasing media buys and creating press releases, tradeshows, and vendor relations programs. Implemented and provided technical database training for Account Managers and clients. Marketing included media planning, promotions, direct marketing, special events, online marketing, market analysis, integrative marketing, etc.
Performed media contract administration reviews, including review of compliance with clients’ plan requests. Obtained additional data to issue new plan contracts and media buys. Also provided interpretation and analysis of contracts and applicable laws for internal/external clients’ media plans.
Created and implemented business, seminars/events, communications and marketing plans for existing, on-line brand products, generating 15% increase in segment revenue within a six-month period.
Negotiated communications, product development and marketing contracts and managed projects with third-party vendors, such as Corel and Microsoft to ensure that online products and technological enhancements were promoted favorably and profitably to the insurance, legal and banking professions.
Planned and executed communications media planning, community relations, seminars/tradeshows and advertising/direct marketing strategies for CD-ROM and Print products in seven states, maintaining an average response rate of 4%. Planned, negotiated and purchased all media buys for twenty-two states, acquiring $625K in cost-savings within an eight-month period. Managed advertising budget of $1.5M, including the media buys for radio, print and Internet.
Launched, and marketed new, on-line products, increasing market penetration level from 46% to 65%. Also, developed client-winning proposals for health benefits, new bank products and legal services and initiatives.
BLUE CROSS BLUE SHIELD OF MINNESOTA AND DELTA DENTAL April 1993 – April 1997
Account Manager
Managed client services, renewals, up-sales, new product introduction and retention of 250+ Employer Groups. Employer Groups sizes ranged from 500 – 10,000+ employees.
Negotiated rate renewals with employer groups, as well as with underwriting and sales divisions.
Successfully renewed and retained corporate health insurance accounts by effectively negotiating rates, creating outstanding customer relations and servicing each customer’s needs, all the while meeting corporate goals for both the client and the company. Retention rate was 98% for 250+ Employer Groups over a three-year period.
MUTUAL SAVINGS BANK May 1988 – April 1993
Marketing Director for all branches
Managed marketing materials production to support all segments of the market.
Fostered close collaboration with the corporate branch to channel periodical feedback from the local markets, in order to drive continuous development of new service and product lines.
Formulated, planned and executed new marketing plans for all product and service launches.
Developed a close liaison with the media and advertising vendors, maintaining the prospect of long-term, strategic alliances and at the same time, buying media at a negotiated cost.
Carried out periodical evaluation on the financial aspects of marketing and product/service development, including budgeting, expenditures, return on investment (ROI), profit and loss analysis, etc.
SEIFERT’S WOMEN’S CLOTHING STORES, KEEPSAKE DIAMOND June 1980 – May 2020
RETAIL STORE, PRISCELLA OF BOSTON BRIDAL SALONS, CHICO’S, ROGERS
HOLLANDS JEWELRY STORE,DAYTON’S DEPARTMENT STOREAND NORDSTROM’S
District Sales Manager, Retail Store Manager, Assistant and Buyer/Manager, Sales Associate positions
Devised marketing plans and effective store strategies to improve sales.
Created store presentations, ideas and concepts to successfully promote store merchandise.
Built strong client base through effective sales and promotional marketing.
Implemented store policies.
Oversaw daily store operations.
Ensured that daily store quota was reached.
Hired, trained, and promoted employees.
Purchased merchandise to meet customer needs.
Responsible for collaborating with cross-functional groups to ensure successful vendor assortment launch.
Developed and executed promotional sales strategy that met/exceeded sales and margin expectations.
Utilized many reporting resources, analyze existing style productivity, vendor performance and deliver recommendations for action plans.
Analyzed industry, competitor, and category trends to identify new product opportunities.
Analyzed markdowns and promotions (instant rebates, promotional markdowns and marketing with OCS/Email)
Developed and maintained vendor relationships; manage vendor performance, including appropriate coaching and corrective discipline as needed to address non-compliance issues.
Maintained on-going communication with the Warranty vendor to develop new offers to optimize product assortment
Provided appropriate coaching and corrective discipline as needed to address non-compliance issues.
EDUCATION
College of St. Catherine, St. Paul, MN
B.A. in Communications with specialty in writing. 2005 Graduate
Saint Mary’s University of Minnesota, Minneapolis, MN
Pursuing a Masters degree in Business Administration, with concentration in Marketing.
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