Management Sales

MARIE LEGOWIK

C: 412-***-****

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

************@*******.***

McMurray,

PA 15317

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

Operations - PRODUCT Development & MANAGEMENT - Account Management

Experienced Management Professional with demonstrated ability to deliver

effective results, build efficiencies, consolidate value-based operations,

creatively manage work teams and achieve strategic objectives. Proven track

record in motivating and managing diverse teams while optimizing results

and client satisfaction. Team player and consensus builder experienced in

overcoming challenges, achieving results under pressure, and consistently

exceeding expectations. Leads by example while communicating shared

vision, instilling team culture and igniting competitive drive. Serves as

corporate ambassador in maximizing global cultural resources and inclusion.

PROFESSIONAL EXPERIENCE AND ACHIEVEMENTS

UPMC Health Plan, Pittsburgh, PA, 2005 - 2009

Manager, Product Development and Management

Improved product portfolio management, market positioning and growth.

Created and implemented 34 new products and programs. Developed effective

product communication and electronic training tools. Led cross-functional

projects that improved the regulatory compliance and timely implementation

of annual product updates. Aligned product management strategies with the

organizational vision and goals. Drafted departmental policies and product

training.

. Led product portfolio management, mapping, analysis and modifications

while effectively managing staff, cost and budget.

. Oversaw administration of over 1500 products including CDHP, Wellness,

Medical, Pharmacy Riders and Certificates.

. Led development, implementation, regulatory filing and strategic

management of HMO, PPO, EPO, POS & CDHP.

. Improved product operational management, communication, marketing

materials, and web-based product tools.

. Successfully implemented regulatory updates by coordinating with cross-

functional teams including medical management, configuration, IT and

regulatory compliance (Annual reporting and filing with DOH, PID and

CMS).

. Led Medicare Part D administrative compliance and communication.

. Implemented electronic training tools and improved product communication

including ongoing product training,

. Volunteered as a translator for UPMC providers and international

patients.

HM Insurance Group, subsidiary of HIGHMARK, INC., Pittsburgh, PA, 2001-

2005

Director of Operations, Healthcare and Medicare Claims & TPA Administration

Achieved measurable operational improvements while leading multiple

divisions including Claims Administration and Compliance; Medical,

Medicare, Dental and Pharmacy, TPA, Health and Welfare administration,

COBRA, Client & Provider Call Center, and COB coordination.

. Spearheaded over 40% improvements in productivity, quality, retention and

client satisfaction. Implemented performance benchmarks, service-focused

management strategies, employee training and quality driven policies &

procedures.

. Renewed over 99% of major clients contributing to profitable growth. P&L

responsibility for $16 million in annual budgets.

. Established lasting business relationships with clients, vendors and

providers through effective sales, renewals and account management.

. Optimized regulatory compliance with internal policies, state mandates

and federal regulations. Oversaw implementation of HIPAA, SOX projects,

and quality and performance metrics.

MARIE LEGOWIK - 412-***-****

Page Two

AETNA, INC., Pittsburgh, PA, 1994- 2001

Sales and Account Management Executive

Successfully managed and retained extensive book of business that consisted

of large, mid and small market accounts contributing to improved revenues.

Surpassed aggressive goals and retention objectives for Medical, Medicare,

Flex Spending, Life, Workers Compensation, Accident, Long Term Care, e-

enrollment and Disability products.

. Achieved business retention goals and close to 100% quota in cross-

selling of new products and services.

. Developed long-lasting client relationships through unprecedented work

ethic, dedication and service excellence.

. Negotiated cost effective renewal rates, plan structures, and ancillary

benefits.

. Produced top results in generating ancillary revenues for the assigned

book of business.

. Demonstrated exceptional problem resolution skills and ability to deliver

excellent services by ensuring timely and effective responses to

benefits, claims and enrollment inquiries.

. Received multiple senior management recognitions for the service quality

and dedication.

. Proven record of overcoming objections and effectively communicating

insurance policies, procedures and benefit information with diverse

clients and providers.

Insurance Sales Support Management

Reported to and assisted the senior management team and District Manager.

Recognized as the subject matter expert by the senior executive management,

clients, sales and account management. Successfully supported sales and

marketing in achieving regional growth objectives and business goals.

. Delivered outstanding consulting support for sales and marketing.

. Coordinated responses for internal and external clients regarding

enrollment, claims and compliance issues.

. Achieved successful results in creating effective marketing and problem

resolution strategies for sensitive accounts.

. Contributed to NCQA and HEDIS projects by effectively coordinating

assignments with operations, medical delivery, providers & quality

improvement teams.

Insurance Claims /Client Services Management

. Effectively led claims problem resolution projects and inquiries.

. Improved responsiveness to external inquiries and client's satisfaction.

. Received outstanding recognition for work performed.

US HEALTHCARE, Pittsburgh, PA, 1990-1994

Claims Analyst

Recognized for outstanding performance, high level of proficiency and

outstanding analytical skills in resolving Medical, Dental, FSA, and

Medicare payment-related claims and ancillary assignments.

. Effectively investigated and assigned benefit payments according to

existing policies and benefit structures.

. Researched and resolved system suspended claims using on-line contract

information, medical coding and policies.

. Performed evaluation of claims disputes, contracted rates and balance

payments.

. Recognized for high financial accuracy contributing to substantial saving

and operational efficiencies.

. Served as a technical translator for selective international claims.

EDUCATION AND PROFESSIONAL AFFILIATIONS

Master's Degree - H.J. Heinz III School of Public Policy and Management,

Carnegie Mellon University

Bachelor's Degree in Economics and Business - University of Pittsburgh

Licensed Insurance Professional in Accident, Health, Life and Fixed

Annuities

Lean Methodology and Boosting Business Results and Quality Certificates

National Association for Female Executives

Alumni Chapter Association Board Member

Vice President - Peters Twp. Boys Basketball Boosters Board

Certification in Advanced Sales Strategies and Negotiation, Boosting

Business Results and Quality

Language fluency in German, Russian and Polish

TECHNICAL SKILLS

MS Windows XP, MS Office, MS Project, MS Access, PeopleSoft, MS PowerPoint,

MS Excel, MS Word, SharePoint, Actuate

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