Kathleen Gauthier

Experience

1. AVP, Claims Operations

   EmblemHealth

   Jun 2022 — Present · Farmington, CT, US

   Responsible for proactively driving enterprise wide claim operations priorities and performance to achieve quality, efficiency, customer experience, strategic goals, and contractual targets whether the processes are embedded internally or at vendors. Lead internal oversight staff and vendor staff to continuously improve operational performance for claims and supporting end-to-end processes. Oversee claim processing value streams of all Medical, Hospital and Dental claims, correspondence and adjustment work, including processing of all high dollar claims. Ensure vendor claim processes and workflows meet business standards, corporate/compliance polices and adhere to all State and Federal Regulations. Responsible for all product lines of business: commercial, Medicare, Medicaid, FEHB, ASO,PPO.

Education

• University of Southern Maine - School of Business

  BS, Business Administration

  1984 — 1988

Skills

• Healthcare
• Call Centers
• U.s. Health Insurance Portability and Accountability Act (Hipaa)
• Vendor Management
• Medicare
• Health Policy
• Claim
• Insurance
• Healthcare Management
• Leadership
• Risk Management
• Process Improvement
• Payment Integrity Management
• Health Insurance
• Managed Care
• Sdlc
• Claims Management
• Team Building
• Management
• Business Analysis
• Business Process Improvement
• Employee Benefits
• Training
• Access
• Hmo
• Provider Relations
• Hipaa