Nicole Davanzo
Director, Payment Integrity & Claims | Healthcare Leader with Grit, Humor & a Track Record of Results
- Role
- Director, Claims Administration and Payment Integrity at Health First
- Location
- Melbourne, FL, US
- LinkedIn followers
- 500 followers
About Nicole Davanzo
I get things done. I build lasting relationships. And I bring grit, resilience, and humor to high-stakes healthcare operations.Senior healthcare operations leader with 20+ years of experience driving claims, compliance, and payment integrity excellence across Medicare Advantage, Commercial, and Marketplace/ACA.I currently lead a department of 70+ associates with a $4.7M budget, 1.8M processed claims annually ($621M in payments) for more than members. Under my leadership, we’ve achieved an 85% claims auto-adjudication rate with a 4-day turnaround time, elevated CMS Medicare Advantage performance from 3 Stars to 4.5 Stars, and positioned the plan in the top 10% nationwide.What drives me is more than metrics, it’s building strong relationships, navigating complex challenges with grit, and bringing a sense of humor to the work. Whether leading through system conversions like our upcoming Epic Tapestry migration, partnering with providers, or guiding teams through regulatory audits, I believe in balancing excellence with humanity.Passionate about advancing healthcare operations through strategy, innovation, and compliance while keeping people at the center.
Experience
Director, Claims Administration and Payment Integrity
Apr 2021 — Present · Melbourne, FL, US
Lead 70+ associates with a $4.7M departmental budget, overseeing over 1.8M claims processed annually ($621M in payments) for Commercial/Marketplace members and Medicare Advantage members.Achieve an 85% auto-adjudication rate with an average 4-day claims turnaround, ensuring timely and accurate provider payments while reducing administrative burden, meeting state and Federal timeliness requirements.Directed Oscar Health Assigned Services Agreement transition and seamless reintegration within 4 months, ensuring uninterrupted claims processing (20••••22).Spearheading enterprise core system conversion from Amisys to Epic Tapestry (Jan 2026 go-live).Elevated CMS Medicare Advantage rating to 4.5 Stars, contributing to improved quality outcomes and incentives.Recognized for compliance excellence during CMS audits and external reviews.
Education
University of Missouri-Saint Louis
Bachelor of Science (B.S.), Registered Nursing/Registered Nurse
1999 — 2001
University of Missouri-Columbia
Bachelor of Science (B.S.), Natural Resources: Parks, Recreation and Tourism
1987 — 1991
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