Tanisha B.

About Tanisha B.

I’m a resourceful, accountable, and adaptive healthcare operations leader with experience supporting claims operations, pharmacy benefit management, and regulatory compliance across Commercial, Medicaid, and Medicare environments.I’ve been trusted to own complex operational work—leading audits, strengthening policies and procedures, and partnering cross‑functionally to resolve issues that impact performance and member outcomes. I specialize in translating operational and data insights into practical, scalable solutions that improve efficiency, reduce risk, and support compliance in fast‑paced, highly regulated settings.Known as a steady, solutions‑driven partner, I adapt quickly to change while maintaining accountability for results. I also bring experience as a Business Analyst, Project Manager, and Mentor, with a strong focus on continuous improvement and collaborative leadership.

Experience

1. Lead Business Operations Specialist

   EmblemHealth

   Mar 2023 — Present · US

   Develop and oversee end-to-end operations processes for the claims department.+ Oversee claims audits, assessing projects, timelines, and risks as a part of the Delegate Vendor Oversight Committee.+ Develop, initiate, maintain, and update policies and procedures for the operations aspects of Products, Accreditation, Contracts, and those that support regulatory requirements.+ Drive and direct implementation of claims processes and operational procedures. Maintain current knowledge of regulatory changes, accreditation standards, and industry rules.+ Coordinates, conducts, and documents delegation audits and monitoring as necessary to follow state, federal, Medicare, Medicaid, NCQA, and any other applicable requirements.+ Monitor and oversee the business activities of various departments that Operations interacts with to gain a comprehensive understanding of all activities. This involves identifying trends and ensuring end-to-end processes are efficient and effective.+ Serve as Operations lead for program audits. Proactively prepare for performing mock audits, perform analysis, and assess risks.+ Work with Operations leadership and teams to provide root cause analysis and corrective action plans.+ Actively support and lead process improvement initiatives that lead to cost savings, improved experience, and maximization of administrative resources.+ Content development, specifically on correspondence tailored for external mail recipients.+ Experience in direct mail print production.+ Perform quality control reviewing to ensure that standards and expectations are met.

Education

• Trevecca Nazarene University

  Doctor of Education - EdD Leadership

• Bowie State University

  Master of Business Administration - MBA, Business Administration

• Tennessee College of Applied Technology - Oneida/Huntsville

  Technical Diploma, Pharmacy Technology

  1998 — 1999

• Belhaven University

  Associate of Arts - AA, Business Administration

  2018 — 2019

• Belhaven University

  Bachelor of Business Administration - BBA, Business Administration

  2020 — 2021

• Liberty University

  Doctor of Philosophy - PhD, Organizational Leadership