2015 Performance Evaluation

Section 1: Associate Information

Name

Natasha Powell

Associate ID

1506863

Job Title

Claims Resolution Analyst Sr

Today's Date

05/02/2016

Business Unit/CEE

TXEX Medicaid IRU-COMMN/6217729900

Manager Name

Kelly Young

Review Period

01/01/2015 to 12/31/2015

Manager Title

Mgr I Claims

Section 2: Goals Weighted at 70%

Customer Service
Goal 1:
20%
Weight:
Measurements:
1. Meets Expectation

Goal 1

Associate

Manager

Rating

Comments

Meets Expectations

I always keep the lines of communication open on any escalated requests. I make to
document the escalation log as well as my appeal tracking so that all can be aware of the
current progress of the appeal. I relay any obstacles that are preventing forward
movement as well as interacting with the appropriate departments to maintain forward
movement on my appeals. I communicate with the provider relations representative if
clarification is needed on a request. I also keep management aware of any barriers that
are preventing forward movement and ask for escalation as appropriate.

Exceeds Expectations

Natasha is a pleasure to work with. Communication to our Health Plan, business

partners and team members is clear and effective. As team lead Natasha points our
Research Analysts in the right direction without giving direct answer. This type of
communication allows the analyst to review and remediate with autonomy. Statement of
Work, Exception Memo submissions are in her own words for root cause / remediation.
This is an area Natasha has consistently remained above her peers in.

Documentation - Appeal documentation must be defined

Goal 2:
30%
Weight:
Measurements:
1. Meets expectation - SOW EM
2. Meets - Finance Reporting

Goal 2

Associate

Manager

Rating

Comments

Exceeds Expectations

I always ensure that my documents are concise and accurate. I make sure the issue of
the appeal is clearly stated, I document my findings in my research documentation to
ensure that PR and whoever else reviews the information will be able to follow the course
and steps that I have taken to resolve the appeal as well as provide supporting
documentation if an appeal is being dismissed or upheld. I provide clear and concise
instructions when routing to other areas for resolution such as PDM. HPS, Claims,
etc.Prior to closing out my appeals, I complete a validation spreadsheet to ensure the
claims were reprocessed correctly, documenting my finds and tasking back to Claims as
appropriate. I keep my tracker up to date and my sure my folder on the O drive is kept
current with my appeal information as well as my tracker. I also make sure to document
any appeals that have financial impact of $100,000 or greater

Exceeds Expectations

Natasha is easily followed behind on research documentation. She again, leads this by
example to the team. Issue's are documented and defined. Rework is submitted with
details required for successful completion the first time. Validation is thoroughly reviewed
and documented prior to project completion.

Production; Resolved Appeals PEGA & MACESS

Goal 3:
25%
Weight:
Measurements:
1. Meets Expectation
2. Exceeds Expectation
3. Doest Not Meet Expectations

Goal 3
Associate

Rating
Meets Expectations

Comments

Goal 3
Manager

Rating

Comments

Meets Expectations

Natasha has meet all expectations in regard to production. As the team lead and the
primary go-to on SB58 issues she remains current. The team is successful due to the
time and hours she dedicates to the staff and then to her own workbasket items. A
manager cannot ask for anything more than what Natasha gives on a consistent basis.

Special Projects, Initiatives, Personal Career Growth

Goal 4:
5%
Weight:
Measurements:
1. Meets

Goal 4

Associate

Manager

Rating

Comments

Meets Expectations

I have taken several courses on My Learning that will allow me to gain additional skill sets
to continue growth in the Team Lead position. I have currently taken: Doing Business
Professionally, Drives Results, Elements of a Cohesive Team, Form Peer Relationships,
Professionalism, Business Etiquette, and Personal Accountability. I have also recently
completed a Health Service Management course which I believe will also give me an
added benefit with my continued growth in the Team Lead role.

Exceeds Expectations

Natasha has imitative and the on line courses she has taken on her own time during
2015 speaks volume's to her work ethic and her commitment to not only herself but her
team. I would like to continue to work with Natasha during 2016 to keep her career path
moving in the Texas market. When an opportunity arises we want to ensure Natasha
ready to go for it!Your team would not be as successful as it is without you Natasha.
Your professionalism and attention to detail are to be commended! Thank you!

Team Lead, One on One's, LSOS support

Goal 5:
20%
Weight:
Measurements:
1. Meets Expectation

Goal 5
Associate

Rating

Comments

Exceeds Expectations

I am always available to assist my team mates on any issues that may have that require
assistance. I have bi-weekly workbasket reviews in which we review all the items that are
in their workbasket to ensure forward movement. Upon completion of the workbasket
review I provide a recap which will allow the associate, Kelly, and myself keep a track of

Goal 5

Rating

Comments
what has been discussed as well as the course of action that needs to be taken. I assist
with finding supporting documentation, training, as well as remediation on issues that
have been previously discussed and addressed. I respond to request and emails in a
timely manner ensure that they have the support they need to complete the task at hand.
I also escalate issues when appropriate to our manager as well as keeping her informed
of any issues or patterns that I may see. I also provide support to the Lone Star
Operations which includes research and resolution of log issues, leading the call with my
counterparts Roy and Detra, as well as keep the log updated for forward movement.

Manager

Exceeds Expectations

During 2015 bi-weekly one on one's were conducted with each team member. The one
on one time allowed Natasha to escalate issues and keep the analyst workbasket in a
manageable state. All team members supplied positive couldn't do it without you
feedback regarding the time you spent with them during the year. As your manager your
ability to multitask and jump in the acting manager role when needed was nothing short of
invaluable to team success. We are thankful to have you as the lead. Leading by
example is what it is all about!

Goal Summary
Goal Rating
Associate

Manager

Exceeds Expectations
Exceeds Expectations

Section 3: Competencies Weighted at 30%

Competencies
Drives results

Associate Self-Assessment

Manager Performance Evaluation

Mastered

Competencies

Associate Self-Assessment

Manager Performance Evaluation

Comments

Takes responsibility

Mastered

Comments

Competencies

Associate Self-Assessment

Builds genuine relationships

Manager Performance Evaluation

Proficient

Comments

Commits to those we serve

Mastered

Comments

Competencies
Finds a way to get to "yes"
Comments

Associate Self-Assessment

Manager Performance Evaluation

Mastered

Competencies

Associate Self-Assessment

Makes the complex simple

Manager Performance Evaluation

Mastered

Comments

Competencies

Associate Self-Assessment

Manager Performance Evaluation

Mastered

Anticipates opportunities
Comments

Mastered

Embraces risk-taking
Comments

Competencies
Acts with integrity
Comments

Associate Self-Assessment

Manager Performance Evaluation

Mastered

Competencies

Associate Self-Assessment

Promotes inclusion

Manager Performance Evaluation

Mastered

Comments

Competency Summary
Competency Rating
Associate
Manager

Mastered

Section 4: Overall Summary

Overall Rating
Associate

Meets Expectations

Manager

Exceeds Expectations

Overall Comments

Section 5: Completion
Associate Self-Assessment Completed
Manager Performance Evaluation Finalized
Associate Performance Evaluation Acknowledged

Date Completed: 12/24/2015

Date Completed: 01/28/2016
Date Completed: 02/26/2016

Appendix: Rating Definition

Performance Rating

Rating Value

Definition
Consistently exceeded or surpassed expected target results that
significantly impact the financial and non-financial success of the
company.
Meaning

Exceeds Expectations

This associate consistently went above and beyond meeting their goals.
They always responded to unusual or unanticipated issues or obstacles.
Work performance resulted in significant gains in efficiency or effectiveness
of operations, business processes, service results or financial performance.
This associate achieved results that "moved the needle" in a significant
way.

Consistently achieved expected or target results that impact the

financial and non-financial success of the company.
Meaning
Meets Expectations

This associate consistently met agreed upon targets, objectives and/or

deadlines.
Both quality and quantity of work met necessary (or required)
standards/expectations.
This associate's performance positively impacted the efficiency or
effectiveness of operations, business processes or services.

Did not consistently achieve expected or target results.

Meaning
Does Not Meet Expectations

This associate did not consistently sufficiently meet targets, objectives

and/or deadlines. Team or business results likely were impacted
negatively.
The quality or quantity of this associate's work did not meet the standards
or expectations