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Customer Service Manager

Location:
Palm Harbor, Florida, 34683, United States
Posted:
May 28, 2010

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Jenny B. Lewis, AIDM

**** ******* **** *****

Palm Harbor, FL 34683

941-***-**** C / 727-***-**** H

abmquu@r.postjobfree.com

http://www.linkedin.com/in/jennyblewis

PROFESSIONAL PROFILE

A recognized specialist in insurance policy and claim administration for

workers compensation, specifically electronic regulatory compliance

reporting; pharmaceutical reporting & analytics, medical services &

equipment reporting and analytics, professional expertise in data

management best practices, data warehouse development and maintenance, data

stewardship, data governance, HIPAA requirements, data analytics and

informatics. Demonstrated leadership and initiative to accomplish directive

to build a new department for a pharmaceutical company under new ownership.

Orchestrated process and work flow improvements to achieve organizational

objectives by providing informatics and analytics presentations to PMSI

Clients. As an Insurance Data Compliance officer, exhibited the ability to

fulfill electronic reporting compliance requirements, articulate technical

communication, project/program development, people development, self

directed, and total quality management that maximizes customer service

potential (aka "Six Sigma"). Well versed in insurance and pharmaceutical

information cycles, and developing system strategies to maximize

organizational efficiency.

Informatics & Analytics Medical Bill Reporting Data Stewardship

Medicare Secondary Payer Healthcare Informatics Electronic Data

Interchange

Unit Statistical Reporting HIPAA Requirements First Report of Injury &

Pharmaceutical/MS&E data Data Governance Subs

reporting & analysis Process Improvement and Electronic Regulatory

Data Warehouse Development turn-around-time Compliance

Information Cycles efficiency Training & Development

Project Management Problem Solving

Processes

Professional Accomplishments

Director of Informatics at PMSI - Pharmaceutical / Medical Services &

Equipment Reporting and Analysis

. Directed the development and improvements in robust client stewardship

packages to give analytical insights into the pharmaceutical spend

affecting work comp medical costs per claim/injured worker.

. Established a process improvement of the timeline and scheduling of

the production steps to produce client stewardship packages.

. Improved the process turn-around times of client report requests and

the line of business owners' operational analysis needs.

. Directed the production of analytical packages with robust analytics

of graphs/charts through use of the Microstrategy BI Tool.

. Business owner of the development of a new Enterprise Data Warehouse

(EDW) project that encompassed the "Out-of-Network" pharmaceutical

transactions through "Third Party Billers" of PMSI clients.

. Directed the IT EDW Development Team, along with the "Operations

Leadership" toward the development of completing organizational

transactions in star schema structure and the ETL process by studying

transactional data and associated information cycles.

. Project owner of resolving major client's data anomalies by working

with IT and the business operations to resolve these obstructers to

data quality in the data warehouse.

Insurance Data Compliance Officer - Zenith Insurance

Unit Statistical Reporting - electronic data reports of policyholder

information and loss experience to national data agents and/or state

rating organizations. Directed the migration of all USR's from multiple

system platforms into a data warehouse through the use of "Informatica"

tool due to mergers/acquisitions and various databases.

. Improved Zenith's NCCI Report Grade of "D / F" rating [which could lead

to loss of operating license] to an "A" within one year, to 100%

accuracy/timeliness in 3 years; a leader in the industry today since 2003.

. Achieved 10% incentive credits from NCCI invoices as a result of

exceeding industry data standard

. Reduced data errors from 500 pages a month in 1998 to less than one page

of errors in 2009

Policy Data Reporting

. Improved Zenith's NCCI Report Card grade from 86% accuracy/timeliness to

99.2%

. Pursued technical advances in electronic policy reporting across the

nation that eliminated all penalties and/or processing fees for each

policy submitted

. Pursued leading technical enhancements with NCCI to maximize job

proficiency for underwriters, that included the electronic experience mod

distribution, electronic industry manuals, electronic invoicing, data

processing tools, underwriting tools. I also negotiated the terms of the

bulk contract for usage to maximize the cost savings.

EDI - Electronic Data Interchange of IAIABC FROI/SROI, Medical Bill Data

. Directed this operation through the development of a direct report, by

arranging membership with the IAIABC EDI Committees involving state

regulators, developing training and depth of the IAIABC standards and

guidelines, along with state implementation guidelines.

. Reported First Report of Injury (FROI) and Subsequent (SROI) in twelve

states with 98% accuracy and timeliness

. Reported FL Medical Bill Reports that exceeds the industry in timeliness

and accuracy

Data Stewardship/Governance Role

. Established a Data Stewardship and Governance role to assure Zenith's

source system changes met all regulatory data compliance standards and

specifications resulting in significant cost savings within system

development and enhancements.

. Instituted "User Acceptance Testing" and "No Harm Testing" requirement

for system changes to preserve data integrity in compliance reporting.

. Member of the NCCI Committee Workgroup developing the "Medical Data Call"

approved by the NCCI Board of Directors to resolve industry issues within

rising medical costs, a designated concern by state regulators.

Member of internal task force to develop corporate accountabilities of

reporting the federal requirement of "Medicare Secondary Payer"

PROFESSIONAL experience

PMSI - Pharmaceutical Benefit Manager, Tampa, Florida

2009-2010

Director of Informatics

Built and developed a team of 7 Analysts responsible for reporting and

analyzing pharmaceutical and durable medical equipment (DME/MS&E)

transactions and spend by clients and for operational effectiveness.

Provided leadership in the production of client stewardship reports

including pharmaceutical spend and transactions encompassing a NDC/drug

analysis within Therapeutic classes, specifically Narcotics Analgesics due

to work comp injury. Business owner of directing the development of the

new "Enterprise Data Warehouse", accomplishing first phase of development

with "Out-of-Network" pharmaceutical transactions through "Third Party

Billers". In the EDW development, I worked with Sr. Architect, ETL, and

PM's in assignments, scheduling and working with offshore teams in design,

infrastructure, QA and problem resolution.

ZENITH INSURANCE COMPANY, Sarasota, Florida

1996 - 2009

Since 1977, Zenith is a specialist in the workers' compensation insurance

Vice President - Data Reporting Services 2003 - 2009

Developed and directed two departments that included an AVP and 12

employees. Instituted operational procedures and performance standards to

assure accurate, complete, and timely electronic data reports and

transmissions. The insurance data management responsibilities included

Electronic Data Interchange (EDI) of policy, claim/loss, and medical data

to statistical reporting agents and state regulators to administer workers

compensation to fulfill regulatory compliance requirements of reporting.

The EDI unit was located in Woodland Hills, California requiring the

leadership and fortitude to manage effectively through the AVP.

Established Sarbanes Oxley performance indicators to validate regulatory

compliance.

Assistant Vice President (2000 - 2003); Manager (1998 - 2000); Information

System Leader (1997 - 1998); Information System Liaison (1996 - 1997)

DICKINSON & GIBBONS, P.A., Sarasota, Florida 1993 - 1996

Systems Administrator (Novell Network 3.12)

Administered a Novell Network system for a 23 attorney law firm.

Duties included, but not conclusive, were: Administered the purchasing,

repair and maintenance of all computer hardware and associated equipment.

Administered the conversion of the legacy accounting and billing system

from an AS400 platform to a PC based application. Negotiated the "online

legal research" contracts which included Lexis-Nexis. Administered all

system applications and replacements, along with ordering software and

installing software. Achieved the highest cost reduction the law firm

experienced in several years that enabled a profit margin at end of year.

FPL Electric Utility, Ft. Lauderdale & Miami, Florida

1975 - 1993

Customer Service Manager of Cashiers and Service Representatives - managed

12 employees who collected money for electric bill accounts, processed and

balanced the cash drawers daily.

Collections Manager - improved past due receivables from the worst in

division to the best in one year. Managed 24 employees.

Supervisor of Call Center in Broward County- managed 21 employees.

TQM Lead Facilitator - being first American company to win coveted quality

award, "Deming Prize". Utilizing Statistical Analysis & Quality Control

techniques for continuous improvement. Trained and facilitated "Problem

Solving Teams" by utilizing statistical quality control techniques for

continuous improvement and process efficiency. Received extensive

leadership training (i.e. "Situational Leadership", "KT", "Executive

Development", and "Managing Diversity") and also became instructor to

other leaders in the use of statistics in decision making. Received "Train

the Trainer" instruction that led to instructing the "Leadership for

Managers" series, "Supervising Quality", "Supervising Teams", "Quality In

Daily Work", and "Employee Orientation". Being a TQM trainer required "Day

Plans" and maintaining training schedule timeline and curriculum for adult

professionals in leadership.

Budget Analyst - responsible for multi-million dollar budget of both

operating and capital expenditures for Broward County Division.

Labor Relations Specialist

Loaned Executive to United Way of Broward County - multiple public

speaking engagements achieving beyond campaign goals

Education

Southern California University, Santa Ana, California

MBA (concentrated in Information Systems); Graduated Magna Cum Laude

Barry University, Miami, Florida

Bachelor in Business Management & Professional Studies, graduated with

honors - GPA 3.83

Certification in "Healthcare Informatics" at University of Phoenix (ETA

8/2010)

Certification focus on EMR/EHR, interoperability and interchangeability of

data, HIT standardization developments.

Professional memberships

International Association of Industrial Accident Boards and Commission

(IAIABC) EDI Committees

Data Control Process Committee for National Council of Compensation

Insurance

Insurance Data Management Association and obtained Associate Insurance Data

Manager Certification (AIDM)



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