Peggy Gedzyk has over 25 years of experience in healthcare operations management. She has a track record of streamlining operations, realizing cost savings, and developing new leaders. Most recently, she led a team that ensured the timely and secure transfer of over 500 million data records between prescription benefit managers. She has also held management roles overseeing medical claims departments and has a background in quality assurance testing.

1. Peggy Gedzyk
Cave Creek, AZ 85331
(847) 414-6373 | peggedzyk@comcast.net
HEALTH CARE OPERATIONS MANAGEMENT PROFESSIONAL
Experienced in creating focus and structure in fast-paced, changing environments. Talented in assessing and
selecting personnel and developing new leaders. Reputation for streamlining operations and realizing cost
savings. Respected for skill in building cross-functional partnerships.
PROFESSIONAL EXPERIENCE
CVS HEALTH, Buffalo Grove, IL 1998 – 2016
A Fortune 8 pharmacy innovation company that incorporates retail and specialty pharmacy services with
prescription benefit management and wellness care clinics to help people on their path to better health.
Sr. Manager, Vendor Transition (EDI) (2001 – 2016)
Formed and led a team of 19 business and data analysts from the ground up that supported the transfer of
prescription, claims, prior authorization andbenefit accumulation data between Prescription Benefit Managers
(PBMs) during client transitions in a wide range of plans including employer accounts, health plans, TPAs,
Medicare Part D, Medicaid and Health Exchanges. Concurrently led a separate cross-functional team of 15
people across 7 operational, technical and clinical departments for a dedicated project in 2015.
 Using electronic data interchange (EDI) processes, ensured the timely, accurate and secure transfer of
over 500M data records in 2015 with a $2M annual operational budget.
 Developed and provided regular, executive-level reporting for all departmental statuses, risks and
action plans and maintained a strong, collaborative relationship across the organization including but
not limited to Mail and Specialty Pharmacy Operations, Clinical Operations, Customer Care Centers,
Medicaid and Medicare Operations, Integrated Benefits, PBM Client Implementations and Account
Management.
 Responded to all departmental RFPs including review, modification and/or approval of performance
guarantees and ensuring ongoing departmental compliance.
 Provided IT project leadership as the primary business owner for numerous large and small-scale
projects. Realizedoperational efficiencies, cost reductions and increased quality by implementing the
following changes within the department:
o Reduced manual effort by pharmacy and support staff on prescription transfers by 50% saving
$100K annually by implementing Refill File standardization in 2005.
o Reduced Customer Service calls relating to transferred prescriptions by 20% by introducing
programming changes that minimized rejects.
o Increased claims load throughput rate by 50% through programming changes that ensured a
higher volume of claims loaded with no rejects upon client go-live and also reduced transfer
completion timelines after go-live.
o Led the initiative to develop new EDI claims transfer functionality for Medicare Part D clients,
reducing regulatory risk for missed edits on claims eligible for transition fills.
o Reduced prior authorization coding errors by 30% by partnering with Clinical and Account
teams to develop a new model of transferring prior authorizations from other Prescription
Benefit Managers.
o Led and directed project to move load and extract programs previously supported by IT to a
self-service model, reducing turnaround time by 50% and reduced re-work by 25%.
Sr. Quality Assurance Analyst (1998 – 2001)
Developed and executed test plans for all applications across CVS Caremark adjudication and mail service
systems, including the build-out of supporting test bed data for all test cases.
 Delivered all application Y2K testing results with zero defects on January 1, 2000.
 Selected as one of only two QA Analysts to attend formal training for Rational Unified Process (RUP)
Testing Suite, then provided training to the rest of the team.

2. Peggy Gedzyk Page Two
BENEFIT SYSTEMS & SERVICES, INC. (BSSI), Westmont, IL 1996 – 1998
A third-party administrator (TPA) providing group benefit plan management, administration and compliance
services for health, dental, disability and Flexible Spending Account plans, in addition to licensing their
proprietary software to clients who administer their own plans.
Sr. Business Analyst
Provided business design analysis for claims adjudication and billing software product changes implemented
by BSSI and performed user acceptance testing as needed. Designed and developed reports through the use
of SQL queries, data file utilities (DFUs) and Microsoft Office data merges and forms.
 Partnered with Provider Network team to develop a semi-automated solution to updating network
changes and printing new directories, reducing manual effort by 90%.
 Reviewed coding for medical, dental and disability claims using expertise in CPT, ICD-9, ADA, HCPCS
and J codes on standard and non-standard billing formats.
Prior employment managing claims departments for several insurance companies, TPAs and managed care
organizations:
UTILIMED, INC. (Diagnostic Imaging Managed Care Company) 1994 – 1996
Claims Investigation Manager and Claims Supervisor for diagnostic imaging claims department.
HEALTHSTAR (Preferred Provider Organization) 1994
Medical Claims Manager for contracted discounts on preferred provider fee for service claims.
GROUP ADMINISTRATORS (TPA) 1989 – 1994
Claims Manager for medical, dental and disability claims for self-insured, fully-insured and Taft-Hartley plans.
EDUCATION AND CERTIFICATIONS
University of Phoenix, AAHCA/Pharmacy Practice, Phoenix AZ, anticipated June 2017
College of Lake County, Foreign Language Studies, Grayslake, IL, 1995 – 2012
Six Sigma Yellow Belt certification, CVS Caremark, 2011
PROFESSIONAL RECOGNITION & MEMBERSHIPS
NCPDP (National Council of Prescription Drug Programs) active member. Led several task groups that
implemented electronic standards for the exchange of member data in the PBM industry. Recognized twice as
an NCPDP MVP and collaborated with council members on other key industry initiatives including, but not
limited to, efforts on EHRs, claims transmission and adjudication, and e-prescribing, 2001 – Present
Formed and led an independent coalition of PBM industry partners that collaborated on increasing data
transfer efficiencies and adapting to industry data demands, 2001 – 2016
Received Caremark’s Director’sChoice Award for departmental and individual achievement above and beyond
goals, 2011
7-Day PMP/PMBOK Conference Study classes, International Institute of Learning, 2005
SOFTWARE SKILLS SUMMARY
Microsoft Office 2000, Microsoft Office XP, Microsoft Office 97 (Word, Excel, PowerPoint, Visio, Access);
Microsoft Project; SQL; SalesForce.