Carmen Winters is a Senior Consultant with BluePeak Advisors. Carmen is an experienced compliance officer and consultant with over 15 years of Federal and State Compliance Program development and management and 25 years of managed care industry experience.
As a consultant, Carmen has taken leadership positions with clients assisting them with both operations and compliance. Recent roles included Interim Vice President of Operations for a start-up MAPD plan offering chronic and dual Special Needs Plans. Carmen spent over a year serving as Interim Chief Compliance Officer for multi-state organization offering PDP, MAPD and SNP products. She has served as the project lead addressing end-to-end business processing, delegation and outsourcing oversight and monitoring, development of cross functional policies, procedures and business process development for all types of MA Plans (CCP, POS, PFFS, EGWP, Special Needs Plans and FIDA/MMP) and stand-alone Part D programs. Carmen also provides assistance with plan benefit package development and marketing material development. She specializes in organizational development, state and federal applications, enrollment, customer service, sales oversight, appeals and grievance management as well as regulatory compliance and oversight, auditing and monitoring.
Prior to becoming a consultant, she served in various roles for local and national Medicare Advantage and Prescription Drug plans in the areas of member services, marketing, appeals and grievances, enrollment, individual programs operations, provider network management and compliance.