Harriet "Happy" Nichols
7658 E. Paseo Laredo, Anaheim Hills, CA. 92808,  [Send email to request phone number] 27- 5936 

DIRECTIVE: A position within an established Corporation utilizing my management,
training skills, large scale auditing abilities and capacity to handle multiple
assignments without the loss of either production or accuracy.
Maintaining/training staff, maximizing their skills & capabilities in pro-active
advance-view techniques. Monitor compliance statutes and ensure conformity on
various levels. To illustrate these ideas and to excel within the Company. To
demonstrate these aptitudes with a high degree of accuracy and timeliness in an
arrangement providing analysis and support to management, state and federal
levels.

EMPLOYMENT: 
2003 - 1/2010 WESTERN GROWERS ASSOCIATION
 Administration Manager for Western Growers Assurance Trust &
 Pinnacle Claims Management, Inc.

* Responsible and experienced in providing operational direction to a staff of
18 Administration personnel in two different cities from a Division of 25 for a
medium sized medical benefits company and third party administrator (TPA) with an
average combined annual income of $156 million
* Development and implementation of successful Administration/Operation
policies, processes, procedures, goals, objectives and Departmental expectations;
identifying unneeded/redundant processes in order to streamline efficiency
* Analysis of Department statistical figures to insure targets were consistently
achieved; implemented changes/modifications on as needed basis
* Initiated review of specific operational programs for consistency with the
ability to perform as designed; recommendation for enhancements
* In charge for all aspects of employee direction of recruitment, peer reviews,
promotions, and dismissals
* Created three key Administration/Operation positions for the continued success
within Division
* Coordinate the activities for team oriented, problem solving, flexible,
multi-tasking workforce
* Committed to meeting the needs of Accounts by supporting communication,
on-site meetings with superior resolution
* Maintain direct contact and coordination with Claims, Customer Service,
Provider Relations, Utilization Review, Auditors, Legal Compliance Counselors,
Reinsurance, Underwriting, Pharmacy, Legal, Accounting and Sales Departments for
optimal interfacing and operational flow
* Ability to create and lead meetings including discussions for various size
audiences
* Ability to train & lead staff in procedures of administration, operations,
policies, auditing, fully/self funded insured products, third party
administration (TPA), accounts payable & receivables
* Support and coordinated annual continuing education programs for reporting
staff
* Improved the existing Participation quality audit process established by
adding Group and Dependent quality auditing process & procedures into the
compliance audits
* Maintained annual KPMG audit accuracy of 100%
* Responsible for many Association wide projects from creation to finishing
point
* Knowledge of HIPAA, ERISA, MEWA, multi state COBRA, Cal-COBRA, EPO, FSA, HMO,
HSA, PPO and TPA administration
* Maintained staff/department/corporation files to including confidential
information
* Participate in SIU (Special Investigation Unit), Fraud and Appeals Committees
* Proficient in a variety of software applications, not limited to Word, Excel,
Outlook, PowerPoint, etc.

2001 - 2003 M.E. ANDREWS & ASSOCIATES
 Underwriting Manager
 * Responsible for implementation and managing all Group & Individual health,
life and dental underwriting for Companies throughout the United States
 * Direct liaison with major Health/Life Carriers, Providers and facilities on a
national basis
 * Ability to monitor State and Federal regulations/laws that have a direct
impact with Group & Individual health benefits to include HIPAA, COBRA, ERISA AND
TPA interfacing
 * Accountable for the maintenance of procedures and guidelines for compliance
within these Industries
 * Maintain direct contact with in-house Sales Division regarding guidelines,
procedures to include superior customer service with Applicants, Clients and
Carriers
 * Experience in resolving difficulties with Carriers as well as Clients with a
positive outcome for all
 * Worked effectively with CEO, to complete personal directive for Corporation
 * Assisted Office Manager with Companies daily operations to include but not
limited to posting payments to Vendors, employee payroll, commissions, every day
activities, etc.
 * Involved with commissions for agents in the Sales Division with direct access
to figures with necessities for accuracy

2000 - 2001 WORD & BROWN
 Underwriting Supervisor
 * Lead person for Group underwriting for cases approved and implemented into a
variety of Health, Dental, Vision, Life and Long Term Disability Carriers
 * Acting manager in managements absence
 * Involved in Individual Family Plan installation for both applicants and
Carriers
 * Ability to mainstream changes to include updates to involved divisions
 * Liaison between internal/external team members and sales force
 * Aid in personal training within division with superior results
 * Assist in creating, updating procedures and guidelines
 * Resolve issues that arise with Health Carriers and employees within Groups to
continue unity for both parties to include Carrier explanation of benefits

1990 - 2000 BLUE SHIELD OF CALIFORNIA
 Medical Underwriting and Customer Service
* Individual and family health plan underwriting - PPO, HMO and small group
accounts
* Completing complex underwriting and correspondence
* Determining eligible risk factors for acceptance
* Reviewing claims for PPO and HMO plan determination
* Troubleshooting and resolution of difficult accounts
* Interfacing procedures with applicants, subscribers and team members
* Identifying quality needs with feedback to team members in a timely and
positive manner
 * Serve as liaison for operational problems* between Claims and Membership
Divisions
* Acting lead in Supervisor's absence
* Responsible for answering high volume of calls
* Analyze issues to answer/resolve complex inquiries to include the
qualifications of interaction with a variety of different divisions including
Legal, Grievance and Consumer Affairs Divisions
* Responsible to meet Member and Broker needs/inquiries

NOTEWORTHY:
* Designed, enhanced and participated in* special projects to improve quality
and procedures within the Medical Underwriting Division
* Chosen for initial organization of Team Concept with* input for success
* Improvement Committee Chair, two years; developing suggestions for procedural
changes to enhance the continuing quality of the Underwriting Division
* Created guidelines and procedures for resolving operational problems
* Identify system problems
* Actively involved in supporting the Claims Division in resolving claims
issues
* Communicate changes to appropriate departments with resolution
* Participated in NMIS Committee for the improvement of Blue Shield's internal
auditing system
* Co-Person for Blue Shield's Safety and Ergonomics Committee overseeing 350
employees

EDUCATION: 

* Participated and certified in The Arbinger Institute Way of Professional
Thinking, 2009
* Participated in Peter B. Stark Employee Opinion Survey 2007 & 2009
* Participated in Management Training seminars, 2004, 2005, 2008 and 2009
* Ongoing COBRA seminars 2003 - Current
* Certified in Group and Individual Health Insurance, Health Insurance
Association of America (HIAA), 1994
* Completed Group Concept, E.D.G.E., Quality Management and Team Building
training programs, 1990 - 1995
* Health Industry, Paraprofessional Institute of Maryland, MA, Honors Graduate,
1983
* Behavioral Management, Montgomery College, Rockville MD, Deans List, 1982
* Computer Science & Speech Pathology, University of Maryland, 1979 - 1981

REFERENCES: Furnished upon request