Allison Lesic has over 15 years of experience in the health insurance industry. She currently works as a Compliance Analyst for Highmark Blue Cross Blue Shield, where she leads projects related to compliance controls and processes. Prior to this role, she worked as a Senior Project Management Analyst and Operational Readiness Analyst, coordinating projects and preparing teams for change initiatives. Lesic has experience in data analysis, documentation, and training. She holds a Bachelor's Degree in Organizational Leadership from Point Park University.

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Allison Lesic
7940 Marmion Drive  Pittsburgh, PA 15237  (412) 849-8149  allisonlesic@hotmail.com
Health Insurance analyst professional with 15 years' experience developing and facilitating the successful
delivery of assigned projects. Goal and deadline oriented with experience in managing one or more projects
within the constraints of time, scope and quality to deliver specified deliverables to meet customer
satisfaction. Adept at building effective, productive working relationships with stakeholders, customers and
team members.
EXPERIENCE
HIGHMARK BLUE CROSS BLUE SHIELD - PITTSBURGH, PA. 01/1998 – PRESENT
Health Plan Operations (HPO) Compliance Controls and Processes (05/2015 – Present)
Lead or participate in activities and projects involving controls, process improvement, NCQA, Privacy, Integrity
& Compliance, Government Compliance or InternalAudit.
Compliance Analyst (05/2015 – Present)
• Direct Pay Audits (DPP) – Lead Analyst for ‘DPP 02 Refund Testing’ for HMK and IBC. Identified and
remediated a particular IBC process for members with Premium Withhold and who also have PACE
by drafting and facilitating updates to the policy. Assisted Senior Compliance analysts with ‘DPP 01
Invoice Creation’ control testing by performing calculations, and by performing the ticking and tying
process retroactiveto January 2015 through current for Highmark and IBC.
• Training Monitoring - Developed an excel tool to simplify and streamline the reporting produced for
HPO management to monitor training course compliance within HPO. Published communications to
management to help monitor and promote compliance for the identified population.
• Clean Desk audits - Worked with another Compliance Analyst and collaborating with a Senior
Internal Communications Analyst from HPO Business Transformation to design a 'Clean Sweep'
theme scorecard for the ‘after business hours' desk audits completed within August through
December of 2015 amid four campuses.
Strategic Operations Program Management Office (04/2013 – 05/2015)
Support the program manager and project managers resulting in enhanced structure, definition and
coordination of key activities.
Senior Project Management Analyst (04/2013 – Present)
• Transparency Program – Created excel documents to report Clarity actuals posted to budgeted hours at
the Transparency Program level and project and associated PR levels (Labor Effort, Burn Rate). Identified
control points and issues then worked with the project managers to resolve unnamed resources and
discrepancies between resource estimates, cost sheets and Clarity. Responsibilities include coordination
with Portfolio Management for Roadmap, Cost Sheets and Business Cases for projects in the
Transparency Program.
• Weekly SO Program Status Meetings – Compile and reformat over 20 program level reports for each
of the SO / IT Cross Functional Weekly Status Meetings and SO / IBC Weekly Status Meetings.
Facilitate these meetings to keep attendees focused, within the time allotted, and followed up action
items.
• Provider Directory Update Meeting with - Prism / HealthSpark / Clarus Health Solutions.
Accountabilities for this vendor included leading the Tuesday morning 'Provider Directory Update
Meeting', creating and maintaining agendas, meeting minutes, and an invitee/attendee mail group.
Facilitating the meetings to keep attendees focused on addressing the agenda items, and escalating
any issues or risks. Following up with the vendor for urgent or agedissues.
Strategic Operations Program Oversight (04/2012 – 04/2013)

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Coordinated operational readiness activities for multiple assigned Strategic Operations initiatives by providing
management with the resources and tools needed to prepare their teams for change with respect to training,
communication, documentation and logistics.
Operational Readiness Analyst (04/2012 – 04/2013)
• Reviewed project materials and collaborated with members of project teams and business owners to
conduct needs assessments, impact analyses, as well as complete training, documentation,
communication and logistics plans for all assigned StrategicOperations initiatives per release.
• Coordinate communications, documentation, training and logistics activities for assigned projects.
• Designed Access database repositories to house Operational Readiness deliverables as well as built
the associated reporting capabilities and authored the manuals for the StrategicOperations
Operational Readiness Team, focusing on delivering consistent information and messaging across
StrategicOperations, customers and business partners.
Legacy Modernization (LM) Project (12/2006 – 04/2012)
Improved operational effectiveness by preparing end users for the impact of LM releases.
Business Integration Liaison – Membership (04/2007 – Present)
• Developed, created and maintained an Access database as well as associated reporting capabilities for
the Business Integration Team to monitor the quantity and status of documentation, communication and
training deliverables.
• Conducted needs assessment for all LM Membership projects by review and analysis of use cases, vision
documents and supplemental specifications as well as interviews with project teammembers and BAU
staff to coordinate communications, documentation and training.
• Created a dashboard status key to provide a consistent measurement for business integration activity
reporting for all Business IntegrationLiaisons.
• Presented Business Integration impacts and materials to customers, management and stakeholders at
quarterly Quality Management meetings.
Documentation Analyst (12/2006 – 04/2007)
• Created documentation to illustrate the business process flow from mailroom to possible claims
adjustment associated to electronic claims with related paperwork attachments.
• Developed and created the on-line help and related documentation for the Mass Adjustment Utility
application.
Transformation Team – Claims Excellence (03/2004 – 12/2006)
Original member of the Claims Excellence Transformation Team tasked with the identification and research of
potential opportunities to improve manual processes or resolve systemic issues affecting Highmark, leading to
more efficient and effective operations and reduced administrative expense along with medical claims costs.
Business Analyst - (03/2004 – 12/2006)
• Created approach documents detailing scope, purpose and recovery savings or future avoidance for
projects. Created implementation plans for avoidance, recovery, and recovery tracking.
• Accountable for data mining and creating audits to track, trend and forecast through the use of Access
and Excel applications to identify opportunities and discover potential inaccuracies in enrollment
benefits, pricing and claims processing procedures.
• Key projects included reduction of Act 68 Interest Penalties, timely filing, prescription copays reimbursed
incorrectly under the major medical line of business, outpatient emergency room visits with related
inpatient stays; projects identified or recovered an annual savings totaling $12,000,000.
• As project lead, trained and mentored audit team personnel.
• Constructed and maintained the department website.
Regional Claims (01/1998 – 03/2004)

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Data collection and inventory reporting coordinator for the Regional Claims commercial and BlueCard
processing and adjustment units.
Business Staff Analyst - (09/2000 – 03/2004)
• Documentation Coordinator for OSCAR Western Region Business, worked closely with the
Documentation Support teamto develop and revise guidelines in Preference and HARRIET for
existing and new suspensions for all lines of business and BlueCard.
• Team Lead for the Medical Secondary Payer Demand Cases project for the COMP IVand ACCLAIM
systems, within Regional Claims.
• Represented Regional Claims in grievance and complaint hearings.
• As project lead, trained and mentored team members.
• Worked with Provider Relations on special projects including LS305 recoveries, write off versus
offset, LS315 recoveries and UPMC priority requests.
Claims Processor/Adjustor/Technical Support Specialist - (01/1998 – 09/2000)
• Adjudicating claims to a finalized state towards either payment or denial.
• Review of adjudicated claims, either for validation of original processing or corrections to original
processing.
• Including but not limited to applying medical policy, benefits and coordination of benefits.
• Testing and supporting documentation needs for OSCAR.
• Assisted in the development of departmental guidelines for coordination of benefits.
Education
POINT PARK UNIVERSITY 2015 –PRESENT
• Bachelor's Degree, OrganizationalLeadership
COMMUNITY COLLEGE OF ALLEGHENY COUNTY - PITTSBURGH, PA 1990 – 2012
• Associates Degreein Business Management - 2012.
• Coding Specialist Certificate - 1994.
• Associates Degree, Nursing - 1990-1992.
NORTH HILLS SCHOOL OF HEALTH OCCUPATIONS - PITTSBURGH, PA 1992-1993
• Medical Assistant Certificate.
NORTH HILLS HIGH SCHOOL - PITTSBURGH, PA 1978 - 1981
• Graduated 06/1981.
SKILLSOFT
• Ongoing Project Coordination training modules 07/2012 – PRESENT