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Charline Tyler
a & G Quality Assurance Senior Manager @Healthfirst
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WORK HISTORY
a & G Quality Assurance Senior Manager @Healthfirst
Columbia, SC, US
Developed and deployed strategic and standardized Appeals and Grievance quality program to achievemaximum performance and quality initiatives across all the department.» Provided oversight of Medicaid and Commercial State Plan, Medicare Advantage, and Integrated/Dual Product quality measure performance.» Reduced manual tasks by 30% and increased productivity by 25% through the development of systems and tools, while providing regular reporting on these activities.» Communicated effectively and concisely through written documentation and verbal presentations, the status of quality performance, program effectiveness, direction, and recommendations for change.» Championed organizational change initiatives to improve Appeals and Grievance Operations and QAperformance, streamlining operational processes and enhancing team collaboration and efficiency» Identified current trends affecting multiple departments and recommended innovative strategies to promote collaboration, resulting in an improvement in cross-functional team communication and streamlined project delivery timelines.» Boosted team productivity by creating documentation, innovative tools, and processes, leading to an overall improvement in employee morale and team performance.
EDUCATION
Jones International University
Master's degree
Park University
Bachelor of Business Administration (BBA)
SKILLS
ABOUT CHARLINE TYLER
As a Quality Assurance Senior Manager at Healthfirst, I lead the development and deployment of strategic and standardized Appeals and Grievance quality program. I have over 4.5 years of experience in this role, where I oversee Medicaid and Commercial State Plan, Medicare Advantage, and Integrated/Dual Product quality measure performance. I have also reduced manual tasks by 30% and increased productivity by 25% through the development of systems and tools.Prior to joining Healthfirst, I worked as a Risk Consultant at PwC for over 5 years, where I established and monitored processes to oversee and coordinate the identification, documentation, reporting, investigation, and resolution of all member appeals and grievances. I also improved project alignment by identifying essential client questions and resolving complex problems, resulting in increased project clarity and client satisfaction. I hold a Master\'s degree in Forensic Accounting from Jones International University and a Bachelor of Business Administration in Accounting and Finance from Park University. I am passionate about ensuring quality and compliance in healthcare and financial services.
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