Kevin J. Sherlock
**** ***** ***** **** (***) *35-
0373
Clarksville, MD 21029
abmrb1@r.postjobfree.com
Professional Summary
An action oriented and results driven executive with a twenty-five year
record of success launching, building and harnessing growing and mature
operations in the Health Claims Administration, Provider Network (PPO) and
Business Process Outsourcing (BPO) sectors. Experience includes: creating
internal systems and operating practices that raise accountability and
productivity; organizing teams of professionals to service unprecedented
growth; direct participation in member, customer and broker interfaces
insuring open communication and satisfaction; profit and loss management;
and virtually every aspect of business operations.
Demonstrated expertise in:
. Process & Time Management
. Strategic Planning
. Organizational Agility
. Hiring & Staffing
. Customer/Broker/Provider Relationship Management
. Managing Quality Systems
. Building Effective Teams
Professional Experience
NCAS/National Capital Administrative Services 2006 -
November 2009
(A CareFirst BC/BS Company)
VP of Operations
Responsible for all aspects of TPA Claims Administration Operations.
. Company Officer and key contributor with decision making responsibility
in all operational areas related to Group Health Plans and Union
business.
. Participated in many aspects of Account Management to include Member,
Customer and Broker support.
. Defined and assisted in the creation of documented procedures for five
operational units to include Claims Processing, Call Center, Network and
Plan Management, Quality/Audit and Electronic Vendor/PPO/Clearinghouse
relationships.
. Key decision maker on claims adjudication platform selection and
development of Blue Card capability.
. Successfully managed to aggressive budgetary requirements.
. Coordinated weekly organizational meetings designed to keep all
Associates focused and working together toward common goals.
. Participated in and presented quarterly results to our Board of
Directors.
Kevin J. Sherlock
Page 2
Emdeon Business Services 2003 - 2006
(Formerly Dakota Imaging)
Director of Business Outsourcing
Managed paper outsourced unit to include Mail Room, Imaging and Data Entry
Operations during unprecedented growth by creating a quality and work flow
management process.
. Created a Quality Program designed to analyze, monitor and continuously
improve internal and customer results.
. Developed an operations staff by instilling in them a unified and
documented focus on common objectives.
. Oversaw the consistent adherence to customer TAT requirements.
. Extensively involved in maintaining and improving customer relationships.
. Played a key role in the creation, implementation and management of
domestic, international and contracted data entry sites.
. Assisted in the creation of multiple Mail Room Operations by developing
Best Practice guidelines which allowed for speedy implementation and high
quality output.
. Responsible for P&L metrics.
. Worked with IT and PSG to analyze and isolate issues on which improvement
would lead to higher quality applications.
USI Administrators
1998 - 2002
Senior VP of Operations-West Region (2001 - 2002)
Organized and created structure by developing measurable tracking and
quality components.
. Harnessed a regional claims office with out-of-control growth by
exceeding industry standards in accuracy and turn-around time.
. Organized and managed Member Service, Enrollment and Eligibility Team
units.
. Created management teams by mentoring, promoting, redeploying and hiring
staff.
. Established goals and a clear vision for management team members by
establishing daily/weekly reporting and results requirements.
. Reinforced upfront fair and consistent internal relationships that led to
open discussion, rapid problem solving and improved performance.
. Cemented client relationships by communicating and proving company
commitment to excellence.
. Successfully headed a national claims adjudication platform conversion.
Kevin J. Sherlock
Page 3
VP of Claims Operations-Northeast Region (1998 - 2001)
When USI acquired W.J. Jones in 1998, successfully merged 3 independent
claims processing organizations into a single, unified Northeast Region
operation.
. Consolidated three small claims operations by setting clear goals,
securing buy-in from the over 100 team members and establishing a results-
driven structure.
. Worked closely with other department heads to achieve a consistent
management approach.
. Achieved one universal set of policies and procedures within 18 months.
. Aided in the identification and implementation of a single adjudication
platform.
W.J. Jones Administrative Services, Inc.
1983 - 1998
VP of Operations/Claims Manager (1988 - 1998)
Instrumental in managing growth as a small, family-run TPA became a major
presence in the Northeast.
. Maintained high quality standards while operation grew 150% from 1/94-
10/98.
. Achieved industry standard 98% accuracy and 14 day claims turn-around
time.
. Trained, mentored and motivated senior staff to tackle growth.
. Influenced all operational decisions as the company moved from 5 to 220+
employees.
. Mastered and managed all aspects of claims administration operations.
. Created structure to accommodate growth.
. Controlled all facility decisions.
Education
Masters Degree in Business Administration
University of Nevada, Las Vegas
B.S., Organizational Management
Nyack College, Nyack, NY