Janine K. Antonis
Suffolk
Summary
Results-driven Business Process Analyst with four years of experience in CMS-regulated Government Programs, Appeals & Grievances, and HICS case management. Skilled in business process improvement, data analysis, and regulatory compliance, leading initiatives that optimize workflows and reduce case volumes. Proven ability to translate regulatory requirements into actionable processes, enhancing operational efficiency in complex healthcare environments.
Overview
8
8
years of professional experience
Work History
Sr. Appeals Representative
UnitedHealthcare
06.2022 - Current
- Awarded Employee of the Month July 2025
- Service Hero Nominee September 2025
- Resolve more than 100 complex Government Program eligibility and appeals cases monthly while ensuring compliance with CMS regulations, contractual requirements, and federal turnaround times.
- Participated in enterprise data analytics initiative that reduced HICS case volume through trend analysis, root cause identification, and process improvement recommendations.
- Participated in an enterprise data analytics initiative focused on reducing HICS case volume through trend analysis, root cause identification, and process improvement recommendations.
- Utilize Excel and Microsoft Copilot to analyze case data, develop formulas, validate findings, and identify opportunities to improve operational efficiency and reduce unnecessary escalations.
- Partnered with cross-functional operational teams to evaluate business processes and recommend corrective actions based on validated findings.
- Identified process gaps and contributed to workflow redesign initiatives, enhancing resolution timelines and operational effectiveness.
- Participated in system testing activities and automation pilots to support business requirements, improve accuracy, and enhance member outcomes and regulatory compliance.
- Develop training materials and provide onboarding support for more than 15 domestic and international employees, improving quality performance and regulatory adherence.
Sr. Clinical Administrative Coordinator
Optum Infusion
08.2021 - 06.2022
- Coordinated patient scheduling and healthcare service delivery activities, enhancing patient access within a regulated healthcare environment.
- Supported operational workflows and documentation processes, ensuring compliance and timely patient care coordination.
- Collaborated across departments to resolve operational issues and maintain regulatory standards, improving service delivery.
- Contributed to process consistency and team effectiveness through strong organizational and communication skills.
Intake Coordinator & CPhT
Parkway Pharmacy
07.2019 - 07.2021
- Coordinated administrative workflows and claims processing to ensure compliance with healthcare regulations.
- Executed processing of insurance and payroll-linked benefit data within pharmacy systems to support operational efficiency.
- Managed administrative workflows and claims processing, ensuring compliance with healthcare regulations.
- Trained all new hires, improving onboarding efficiency and reducing errors.
- Guided employees and patients in navigating financial support options, showcasing empathy and effective problem-solving.
Certified Pharmacy Technician
Community Medical Center
03.2018 - 02.2020
- Coordinated technician workloads to enhance accuracy and streamline operations.
- Executed quality inspections and documentation reviews to uphold compliance and ensure patient safety.
- Collaborated with pharmacists and nursing staff to facilitate communication and prioritize patient-centered care.
Education
Bachelor of Science - Business Administration
Southern New Hampshire University
01-2024
Appeals & HRA Development Analyst Program
UnitedHealthcare
01-2025
Employee of the Future Program
United Healthcare
01-2025
Workday Education
Workday
01-2025
Skills
- Business Process Analysis: Requirements validation, Process improvement, Workflow optimization, Root cause analysis, Gap analysis, Operational readiness, Change management, Process documentation
- Testing & Operations: User acceptance testing, System testing, Claims processing, Claims verification, Defect identification, Quality assurance, Audit readiness, Regulatory compliance
- Regulatory Compliance, Appeals & Grievances, HICS case management, Marketplace & Exchange eligibility, Medicare, Medicaid, Healthcare operations, Policy interpretation
- Data & Technology: Excel (Advanced), Pivot Tables, VLOOKUP/XLOOKUP, Microsoft Copilot, Microsoft Office, Power BI, SQL (Foundational), Trend analysis, Dashboard Monitoring
- Leadership & Collaboration: Stakeholder Management, Cross-functional collaboration, Training onboarding, Vendor coordination, Executive documentation, Change communication
Timeline
Sr. Appeals Representative
UnitedHealthcare
06.2022 - Current
Sr. Clinical Administrative Coordinator
Optum Infusion
08.2021 - 06.2022
Intake Coordinator & CPhT
Parkway Pharmacy
07.2019 - 07.2021
Certified Pharmacy Technician
Community Medical Center
03.2018 - 02.2020
Bachelor of Science - Business Administration
Southern New Hampshire University
Appeals & HRA Development Analyst Program
UnitedHealthcare
Employee of the Future Program
United Healthcare
Workday Education
Workday