Summary
Overview
Work History
Education
Skills
Websites
Extracurricular Activities
Timeline
Generic

Caressa Dempsey

Dunmore

Summary

Dynamic leader with extensive experience at Cognizant Technologies, excelling in claims operations and regulatory compliance. Proven track record in enhancing automation rates and improving quality scores. Skilled in budget management and performance evaluation, fostering team development and client relationships to drive operational excellence and exceed service level agreements.

Overview

20
20
years of professional experience

Work History

Director, Head of Global Delivery Claim Operations

Cognizant Technologies
Scranton
01.2020 - Current
  • Directed leadership support and service delivery for Claims Department within Government Program BPASS framework.
    Oversaw operational functions including claims processing, provider relations, and regulatory compliance.
    Conducted performance evaluations and professional development for direct report associates.
    Constructed a regulatory framework to support government program compliance requirements.
    Managed budgeting processes and ensured adherence to corporate financial metrics.
    Facilitated training for global teams on government program business during transformation efforts.
    Enhanced configuration quality program leading to improved automation rates and claims accuracy.
    Spearheaded internal initiatives as Executive Sponsor to boost service delivery outcomes.

Deputy General Manager

Cognizant Technologies
04.2016 - 12.2019
  • Provide leadership support and service delivery for 12 Medicaid and Medicare Advantage clients within the Government Program BPASS model. Responsible for providing performance evaluation and development to all direct report associates. Trusted with providing budgeting and forecasting metrics to operate the Claims Department within corporate requirements. Oversee government program operations for claims, provider relations, automation, pre-processing, imaging and mailroom departments. Trained global team in government program business during offshore transformation. Responsible for management oversight and financial costs associated with 350+ employees globally. Develop and Implement process excellence initiatives to increase auto adjudication run rates, improve quality scores and draft policies and procedures. Trusted in aligning operational initiatives to meet and exceed contractual service level agreements and maintain compliance with government program requirements. Serve as the Executive Sponsor for internal initiatives to drive higher level delivery to our clients. Trusted in managing vendor relationships.

Configuration Analyst III

TMG Health
01.2014 - 04.2016
  • Trained newly on-boarded Configuration Analysts on organizational best practices. Served as Lead Configuration Analyst on largest MAPD client with over 100k members. Trusted to provide quality analysis of configuration best practices. Drafted best practice documentation and training materials. Experienced in Facets system configuration (all modules) including, enrollment, premium billing, and benefit, pricing and provider configuration. Trusted in managing regulatory requirement changes and updates for distribution and system configuration across all clients.

Claims Manager

TMG Health
01.2008 - 12.2013
  • Trusted as client partner in delivering operational excellence as required per service level agreements. Responsible for inventory management and work distribution for assigned accounts. Develop training, quality and performance metrics for a staff of 30 resources. Serve as Claims subject matter expert and liaison to the Account Management team. Responsible for resource allocation across plans to meet operational metric requirements.

Business Analyst

TMG Health
06.2005 - 12.2007
  • Trusted in serving as the subject matter expert for Claims Operations in new client implementations. Draft and manage business requirement documents for system development. Engage and build client relationships through service delivery. Responsible for drafting, publishing and implementing all department policies and procedures.

Education

B.S. - Speech Communication

Millersville University of Pennsylvania
05.2005

Completed Two Years of Undergraduate Studies -

Duquesne University
05.2003

Academic Diploma -

Dunmore High School
06.2001

Skills

  • Advanced computer skills (Microsoft Suite, SQL)
  • Claims adjudication and configuration
  • Medicare and Medicaid compliance
  • Operations management and forecasting
  • Process excellence and automation
  • Root cause analysis
  • Regulatory compliance
  • Budget management and oversight
  • Performance evaluation strategies
  • Vendor and contract management
  • Training facilitation and employee development
  • Client relationship management
  • Data analysis techniques
  • Team leadership and project management
  • Strategic planning initiatives
  • Quality assurance practices
  • Market analysis insights
  • Intellectual property oversight
  • Business development strategies

Extracurricular Activities

Co-founder and chair of Team Breathe Easy dedicated to raising funds for the cystic fibrosis foundation.

Timeline

Director, Head of Global Delivery Claim Operations

Cognizant Technologies
01.2020 - Current

Deputy General Manager

Cognizant Technologies
04.2016 - 12.2019

Configuration Analyst III

TMG Health
01.2014 - 04.2016

Claims Manager

TMG Health
01.2008 - 12.2013

Business Analyst

TMG Health
06.2005 - 12.2007

B.S. - Speech Communication

Millersville University of Pennsylvania

Completed Two Years of Undergraduate Studies -

Duquesne University

Academic Diploma -

Dunmore High School

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Caressa Dempsey