Kyle Tschetter
Sioux Falls
Summary
Detail-oriented Implementation Analyst with proven skills in user acceptance testing, system configuration, and technical troubleshooting. Known for optimizing workflows and enhancing stakeholder communication.
Overview
24
24
years of professional experience
Work History
Tapestry Implementation Analyst
Avera Health Plans
Sioux Falls
11.2024 - Current
- Analyzed implementation processes for health plan systems and software.
- Collaborated with cross-functional teams to optimize workflow efficiency.
- Coordinated user acceptance testing to ensure system functionality meets requirements.
- Facilitated communication between stakeholders to address project milestones.
- Assist in troubleshooting technical issues related to health plan applications.
- Monitor progress of implementations projects throughout the development life cycle.
- Participated in design sessions with developers to ensure accuracy of system configuration according to project requirements.
- Help resolve issues related to application configuration or setup during testing phase by troubleshooting problems as they arose.
- Identified opportunities to improve business processes through automation or other enhancements.
- Gathered requirements from stakeholders through interviews, workshops, surveys and document analysis.
- Configured software settings to meet customer needs based on functional specifications.
- Reviewed established procedures to assess areas in need of improvement.
Appeals and Grievances Coordinator
Avera Health Plans
Sioux Falls
12.2015 - 10.2024
- Coordinated appeals process for member inquiries and grievances at Avera Health Plans.
- Reviewed and analyzed claims data to ensure compliance with regulatory standards.
- Collaborated with healthcare providers to resolve member issues and concerns effectively.
- Documented appeal resolutions and maintained accurate records within the system.
- Assisted in training new staff on appeals procedures and best practices.
- Communicated clearly with members regarding the status of their grievances and appeals.
- Engaged with cross-functional teams to improve overall member satisfaction initiatives.
- Conducted meetings with stakeholders to discuss issues related to appeals or grievances.
- Identified areas where additional training may be required for staff members dealing with customer complaints.
- Prepared written responses to customers regarding the status of their appeal or grievance filings.
- Maintained accurate records of all activities related to appeals and grievances.
- Interpreted external regulations governing the handling of appeals and grievances.
- Researched case files to ensure accuracy of information prior to making decisions on appeals or grievances.
- Coordinated review by internal teams of submitted appeals or grievances.
- Drafted reports summarizing findings from investigations into appealed or grieved matters.
- Assessed customer complaints to determine eligibility for appeal or grievance filing.
- Provided oversight of appeals and grievances process, ensuring compliance with applicable regulations.
- Analyzed complex cases to determine appropriate resolution in accordance with relevant laws, regulations and organizational policies.
Customer Service Representative
Avera Health Plans
Sioux Falls
11.2010 - 12.2015
- Assisted customers with inquiries and resolved issues promptly.
- Educated members on health plan benefits and service options.
- Coordinated with internal teams to address customer needs effectively.
- Handled billing inquiries and clarified payment processes for members.
- Provided training to new staff on customer service protocols.
- Maintained detailed records of customer interactions and transactions.
- Answered customer inquiries and provided accurate information regarding products and services.
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Developed positive relationships with customers through friendly interactions.
- Provided exceptional customer service to ensure customer satisfaction.
Customer Service Representative
HSBC Card Services
Sioux Falls
12.2001 - 11.2010
- Assisted customers with inquiries and resolved issues promptly.
- Managed account updates and ensured accurate information entry.
- Coordinated with internal teams to address customer needs effectively.
- Handled billing inquiries and clarified payment processes for members.
- Provided training to new staff on customer service protocols.
- Maintained detailed records of customer interactions and transactions.
- Developed scripts for common customer queries to streamline responses.
- Answered customer inquiries and provided accurate information regarding products and services.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Maintained detailed records of customer interactions, transactions and comments for future reference.
- Resolved complex problems by working with other departments to provide solutions that meet customer needs.
Education
High School Diploma -
Washington High School
Sioux Falls05-1996
Some College (No Degree) - Finance
University Center-USD
Sioux FallsSome College (No Degree) - Information Technology
Killian Community College
Sioux FallsSkills
- Implementation analysis
- User acceptance testing
- System configuration
- Workflow optimization
- Technical troubleshooting
- Stakeholder communication
Timeline
Tapestry Implementation Analyst
Avera Health Plans
11.2024 - Current
Appeals and Grievances Coordinator
Avera Health Plans
12.2015 - 10.2024
Customer Service Representative
Avera Health Plans
11.2010 - 12.2015
Customer Service Representative
HSBC Card Services
12.2001 - 11.2010
High School Diploma -
Washington High School
Some College (No Degree) - Finance
University Center-USD
Some College (No Degree) - Information Technology
Killian Community College