About
Tori Stevens is a Senior Healthcare Payer Analyst with six years of cross-line-of-business experience spanning Medicare, Medicaid, and Marketplace. Her background includes financial reporting, reimbursement configuration, and compliance analysis within managed care organizations, with a track record of driving significant improvements in operational accuracy — including a 70–96% compliance improvement in claims processing workflows.
Experience
Senior Analyst, Reimbursement Configuration
Molina Healthcare | February 2020 – February 2026
Led reimbursement configurations, financial impact reporting, and compliance analysis across Medicare, Medicaid, and Marketplace lines of business in a multi-state managed care environment. Managed bi-weekly manual pricing configurations across 6 states including UAT, production deployment, and validation. Produced enterprise Financial Impact reports for CMS rate changes. Proposed and implemented a tiered analyst model that improved team-wide compliance from 70% to 96%. Built Excel-based tools that standardized configuration parameters enterprise-wide. Audited medical claim pricing for appeals, grievances, and senior leadership escalations. Used SQL and Databricks to pull complex multi-database reports for business needs and urgent escalations.
Independent Medical Advocate & Caregiver
Self-Employed | 2011 – 2019
Served as primary caregiver and medical advocate for a family member with a terminal illness, managing all aspects of care coordination including medication schedules, physician appointments, pharmacy consultations, and drug interaction oversight. Navigated complex insurance coverage disputes, lodged formal complaints with hospital administration, and successfully secured medical coverage and SSDI disability approval through documentation, record collection, and persistent follow-up. This experience provided direct insight into the patient and family experience within the managed care system.
Data Analyst
Aetna | 2015
Supported systems migration and configuration projects; built performance tracking reports for management; created detailed process documentation.
Additional Experience
Earlier roles include Billing Specialist (Mach1 Air Services), Accounting Specialist III (Levi Strauss & Co.), and
Co-Owner/Operator (Stevens Technical Service), with experience spanning accounts payable/receivable, payroll, process automation, and web design.
Education
Education & Compliance Training
High School Diploma — Graduated Top 12% of Class
HIPAA Compliance & Protected Health Information (PHI) Training — Molina Healthcare
Fraud, Waste & Abuse (FWA) Compliance Training — Molina Healthcare
Career Milestones
Compliance Transformation
Proposed and implemented a tiered analyst model that improved team-wide compliance from 70% to 96% — subsequently assigned oversight of all reporting inventory and monthly analysis of hundreds of thousands of claims.
Recognized for Complex Analysis
Consistently recognized by leadership for advanced analysis of enterprise Financial Impact Reports, with a track record of translating high-complexity CMS rate change data into clear, actionable reporting.
Enterprise-Wide Excel Innovation
Conceived, designed, and built an Excel workbook that standardized Financial Impact Report parameter selection across the organization — making reports more accurate and accessible for analysts at all experience levels. Collaborated in cross-team meetings to refine and validate the final version, provided final input and review, and led rollout to all Configuration teams enterprise-wide via distributed links to ensure consistency across all relevant teams.
Cross-State Stakeholder Leadership
Led regular meetings with business stakeholders and leadership across 6 states covering ticket inventory, regulatory change tracking, priority alignment, and deployment timelines.
Go-To Excel Subject Matter Expert
Repeatedly called upon across teams to resolve advanced Excel challenges beyond intermediate skill level — and designed enterprise-wide tools including semi-automated configuration workbooks and independent claim pricing calculators adopted across the organization.
Mentorship & Knowledge Transfer
Trained and mentored Junior, Senior, and Lead Analysts in a fast-paced environment, tailoring instruction to individual learning styles. Regularly fielded calls from teammates and cross-functional staff to explain complex Financial Impact Reports and teach processes that improved their efficiency. When joining the team, enterprise Financial Impact Reports were so complex that only the manager could explain them to stakeholders — through consistent knowledge transfer, that expertise was distributed across the team.
Contact
Senior Healthcare Payer Analyst open to remote opportunities. Reach out to connect.
Email Address: tmstevens.analyst@gmail.com