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Management Quality

Location:
Clarksville, Maryland, 21029, United States
Posted:
May 26, 2010

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Kevin J. Sherlock

**** ***** ***** **** (443) ***- ****

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



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