Project Manager

R UTH ELAI NE SMI TH

**** ******** ** *******, **. 30040

6-78-771-**** (h) or 678-***-**** (c) M ***********@***.***

OBJECTIVE

A position as in an organization that will utilize the skills and experience I have amassed through-out my

professional career.

SKILLS PROFILE

Strong organizational, analytical and project management skills with a proven record of completing deliverables

on time and within budget

Over 20 years of experience in Group, Small Group, Individual and HMO Health Insurance Enrollment, Billing,

Accounting and Claims systems (Health, Dental, Vision and Short-Term Disability) Fully insured and self

insured experience. Experience with HMO PCP payment processing, referrals and management reporting.

Marketing presentation development and delivery including RFP/RFI development

Experienced in Waterfall development methodology and various Project system development lifecycle

methodologies. Familiar with Agile and Scrum.

Advanced user in all Microsoft office tools, including Visio, Project, Powerpoint, Excel, Access, and Word.

Demonstrated ability/experience in leading process improvement initiatives

Ability to work effectively in a cross-functional matrix organization

Excellent written and verbal communication skills

Strong facilitation and work group management skills

Ability to interface effectively and establish a relationship of trust with customers and IT

Leadership skills

Flexible and adaptable to changing priorities

Mainframe, Client-Server and Web Client application experience

PROFESSION AL EMPLOYMENT HISTORY

Sr. Project Manager, BlueCross BlueShield of South Carolina 1/1/2001 Current

Columbia, SC

Development, maintenance and management of detailed project plans outlining tasks, deliverables, effort

and resources required for successful implementation, accountability for and ownership of project

deliverables. Created and executed project work plans and revised as appropriate to meet changing

needs and requirements, ensured reviews/approvals of deliverables and change controls were completed

prior to passing deliverables to customers. Maintenance of multiple forms of weekly project status.

Mitigated conflict and communication problems within the teams, with customers and outside vendors.

Tracked and managed project issues to closure, escalated when appropriate. Provided Client service for

large scale Commercial and Government accounts. Established the initial desk reference for project

leaders that is now a formal reference book used in orientation of new project leads.

Examples of projects:

Mega Projects

New billing system complete with email and web-based interfaces as well as a re-designed bills and

letters custom to each line of business. This project involved corporate communications to approve the

final bills and use of a focus group during development of the bill formats for ease of use, it also

involved bar-code technology and mail-room testing for separation of bills by size for the correct

envelopes. There had been 3 previous attempts to complete this project and all had failed. I was the

first project leader to successfully complete the project and use the full SDLC with these teams. With

this project I established processes and tools for tracking and reporting that are still being used today.

Duration: 18 months,

Team Size: 26 IS project teams

Status: Completed on time and within budget.

Converted several lines of business off of a legacy enrollment system on to a relational database

based enrollment software system. (Lines of Business included ASO, Dental only, Small Group and

Individual.) Included conversion of electronic enrollment files, customization of the system, a pilot set

of data and roll-out of subsequent conversions.

Duration: Each of these 4 projects took a year.

Team Size: 26 IS project teams, 5 teams remote

Status: Completed on time and within budget.

Large projects:

A new delinquency module to include automated follow-up letters with user controlled custom

frequencies at all levels. Acquired this project when it was behind schedule and over budget. Applied

organizational processes and project methodology returning the project to a positive status.

Team Size: 4 development teams and 20 sub-teams to support positive and negative testing.

Status: Completed on time and within budget.

Enhanced and fine-tuned a new financial accounting system, this project included development of

balancing reports and automated processes for crosschecking and reporting out of balance conditions.

This was a follow-on project to correct balancing issues with a newly developed financial system and to

ensure SOX requirements were met. Customers included Corporate Finance, Commercial Individual

and MedAdvantage and an Affiliate MedAdvantage partner. This project eliminated a time consuming

manual process that was occurring since the initial implementation of the accounting system.

Duration: 1 year

Team Size: 1 development team, 2 support teams for testing.

Status: This high priority project was completed on time and within budget and had interim

deliverables.

Scope document for a new internal security module for the Enrollment and Billing systems. Duration:

3 months.

Team Size: 3 IS development teams

Status: This project was started and then put on hold due to higher priority projects underway at the

time.

Standard electronic eligibility feed layout to be used for ANSI X12 834 enrollment transactions as well

as proprietary files. Included development of a User set of menus to enable the BCBSSC Users to

setup new inbound files without IT assistance as long as the format was one of the standard layouts.

This was my first project at Blue Cross and was run with the full SDLC. I received compliments on the

clarity and detail of the scope document. This process is still in place today and became the

foundation used for enrollment system conversion of existing business and for new business as well.

Duration: 1 year

Team Size: 4 development teams

Status: Completed on time and within budget.

Small Projects:

Enhanced the outbound interface file for transmittal of eligibility information to the current drug vendor.

(Advance) This was a clean-up project to address numerous issues that were causing incorrect

enrollment information to be transmitted. This project was 1 year in duration with a single project team.

This project was completed on time and within budget.

Created an Excel template to be used for RFP estimating and assisted in the response to 3 RFP’s

through submission. This tool would create the initial high level scope estimate by system area, by

objective and by estimating manager for new projects if the contract was awarded to BCBSSC. In

addition it housed the exact modules estimated in the proposal including custom options for reference

post sale. This was an internal highly visible PMO two month project where I did the actual setup of

the excel templates working with the CFO, Design Architect and Upper management levels at Blue

Cross.

Integrated a tracking module into the interstate transfer claims system (ITS) used by Blue Cross for

non-host claims. The tracking module had touch points throughout the claims journey from point of

receipt though return remittance to the sending entity. This project enabled IS to quickly find claims

that were getting “lost” or held up in the process for speedy resolution. It also enabled instant metrics

for turnaround. Immediately after implementation this process found a substantial number of claims

that had been held up in the process and enabled IS to rapidly resolve the issue within SLA

timeframes. This was a 6 month project involving 2 teams that was completed on time and on budget.

Director of Technical Support, UICI Administrators 8/8/1988 12/20/2000

Irving, TX

Develop, maintain and manage detailed project plans outlining tasks, deliverables, effort and resources

required for successful implementation. Accountability and ownership of deliverables for new and existing

business. Management of day-to-day operations of the System development area. Marketing presentation

to prospective customers and sales of additional services to existing customers. Recruiting, selecting,

orienting, training, assigning, scheduling, coaching, counseling, and disciplining employees; communicating

job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing

compensation actions; enforcing policies and procedures.

Examples of Projects:

Implemented the United Mine Workers Fund (The Funds) on the Insurdata system. This was a 1

year project that included requirements gathering, system setup, plan loading, and auto-

processing rules. I served as the focal contact representing UICI for requirements gathering,

coordination with our software vendor, and managed the internal support team performing system

configuration and benefit plan load. This project was completed on time and I received a

$10,000.00 bonus for my part in achieving an auto-processing pay through rate of 90% on the first

claims out the door. (Our contract only required an 80% pay through rate.)

Enhanced the Insurdata claims processing system to accommodate Individual business with

riders for health and dental. This included changes to the plan load modules and processing

rules, design of the systems modules to handle riders and testing of the new enhancements.

Enhanced Claims EOB formats to include a user controlled free form message. Also consolidated

EOB messages so they would only print one time on the EOB and have an indicator by line item

for those lines each was applicable to.

Implemented New ASO clients on the Insurdata system including having the client specific logos

scanned into the system for inclusion on ID cards, Letters, EOB’s and Monthly reports.

Implementation included analysis of benefit requirements, customization of the system to handle

unique benefits, testing of the customizations, benefit plan load/setup, system region setup,

keying of letter templates, setup of auto-processing rules for health, dental and vision claims,

format and approval of ID cards, development of custom reports for daily, weekly, monthly or

annual automated distribution.

Mentored staff in benefit plan load and auto-processing rules setup. I also managed technical

support for the ERISCO Facets system used for HMO look-alike processing. With my team I was

able to stabilize the systems issues for several customers that were unhappy with the TPA when I

came on board and was able to retain their business.

From 1982 to 8/8/1988

Have held positions of increasing responsibility including 5 years as a Health and Dental claims

processor, 15 years as a software tester, 13 years as a business analyst, 2 years as a marketing

client service representative, and 4 years as a benefit plan loader. I have experience as a report

writer and operations manager of a technical area and auditing department. I started and

received initial claims processing training at Equitable Life. Other employers have included

Jefferson Pilot Life, Pacific Mutual, Aetna and Harris Methodist Hospital. Details and dates of

employment can be provided on request.

ACTI VITIE S AND EDUCATION

Fernandina Beach High School, Fernandina Bch, Fl – Graduated 1975

Florida Junior College at Jacksonville, Jacksonville, FL – General College transfer studies

University of Florida, Gainesville, Fl – Broadcasting Major

Project Management – Furman University – PMP Certification Course

Multitudes of professional enrichment courses, transcript available at interview.

References provided on request

Contact this candidate