Ashle Pegues

Healthcare Operations and Patient Access professional with 7+ years of experience driving operational excellence across payer, provider, public health, and digital health environments. Demonstrated expertise in optimizing patient access workflows, streamlining care coordination, and leading high-volume operational initiatives that measurably improve outcomes and efficiency. Adept at navigating complex insurance authorization and reimbursement systems, bridging clinical and administrative functions, and building sustainable processes that reduce access barriers for patients.

Recognized for exceeding performance benchmarks, managing multistakeholder operations under pressure, and translating data insights into actionable quality improvements across diverse healthcare settings.

Claims & Insurance Operations Specialist at State Farm (2023-07 – Present)

Manage complex end-to-end insurance cases in a high-volume, compliance-driven environment, serving as the operational bridge between policyholders, clinical stakeholders, and internal teams.

• Interpret and apply policy coverage terms, reimbursement structures, and claim resolution protocols within a strictly regulated operational framework
• Coordinate cross-functional resolution workflows between internal departments and external partners, ensuring timely case closure and service recovery
• Maintain audit-ready case documentation and adherence to SLA benchmarks across a high-volume case portfolio
• Apply deep payer and insurance operations knowledge to identify process improvement opportunities and reduce resolution cycle times

Account Manager – Provider Operations at PatientPoint (2021-08 – 2022-12)

Led provider onboarding, engagement, and platform adoption operations for a national healthcare technology company, managing a territory of physician practice accounts.

• Exceeded provider recruitment targets by 195%, successfully onboarding 59 primary care providers to the platform within a single quarter
• Designed and executed structured onboarding workflows to ensure provider readiness, staff training, and operational go-live within defined timelines
• Managed ongoing provider engagement and utilization reporting using Salesforce CRM, identifying accounts at risk and proactively addressing adoption barriers
• Partnered with clinical and operations teams to resolve escalations, optimize workflows, and improve the provider and patient experience

Operations Lead (Contract) at St. Louis County Dept. of Public Health (2021-03 – 2021-08)

Directed day-to-day operations for a large-scale COVID-19 vaccination program, managing multi-site coordination, staffing, and patient flow across a high-volume public health initiative.

• Oversaw operational delivery of 100,000+ COVID-19 vaccinations across multiple community sites, ensuring efficiency, safety, and compliance
• Optimized patient flow, appointment scheduling, and resource allocation to maximize throughput while maintaining a positive patient experience
• Coordinated cross-functional teams including healthcare staff, logistics personnel, and community partners to maintain seamless operations
• Developed and enforced operational SOPs to ensure consistency, regulatory compliance, and quality of care delivery across all sites

Health Guide – Care Coordination (Contract) at Vida Health (2020-09 – 2021-04)

Provided non-clinical care coordination and patient navigation for a digital health platform focused on chronic condition management and member engagement.

• Coordinated care plan adherence and patient access to digital health resources for a caseload of members with chronic conditions
• Served as the primary operational point of contact between patients and clinical care teams, facilitating communication and continuity of care
• Maintained detailed case documentation within digital health platforms to support care coordination, compliance, and handoff accuracy
• Drove member engagement and retention through proactive outreach, health education, and program navigation support

Patient Navigator at Mercy Virtual Care Center (2019-01 – 2020-05)

Managed patient access operations for a virtual care center, serving as the primary liaison between patients, providers, and specialist networks to ensure coordinated, timely healthcare delivery.

• Managed end-to-end patient scheduling, specialist referrals, and insurance verification for a high-volume telehealth service line
• Navigated complex insurance authorization and prior authorization requirements to eliminate access barriers and ensure timely care delivery
• Maintained accurate documentation in Epic EMR to support care continuity, regulatory compliance, and case handoffs between care team members
• Proactively identified and resolved operational bottlenecks in care coordination workflows, reducing patient wait times and improving satisfaction

Clinical Quality Data Analyst & CHW at BJK People's Health Centers (2016-09 – 2019-01)

Supported healthcare operations, quality improvement, and population health analytics for a federally qualified health center serving an underserved patient population.

• Conducted population health analytics and clinical quality reporting to identify care gaps and drive data-informed operational improvements
• Led patient access initiatives that reduced barriers to care, improved appointment utilization rates, and expanded service reach within the community
• Analyzed clinical quality metrics against FQHC benchmarks and developed actionable recommendations adopted across multiple service lines
• Conducted community outreach and health education to support patient engagement, preventive care utilization, and continuity of care

Bachelor of Arts in Health Studies – University of Iowa