Customer Service Manager

JAMES (JAY) F. STEIN

*** ********* ***** *****: 925-***-****

San Ramon, California 94583 Email: *****.*******@*******.***

QUALIFICATIONS SUMMARY

Pragmatic, engaged, results-oriented leader with proven experience developing & leading client service operations to

deliver increased efficiency, profitability, market share, & customer loyalty:

Unique combination of carrier, employer HR, & intermediary vendor roles providing significan t exposure to a

variety of customer service, plan set-up, SPD & contract drafting, eligibility/payroll data exchange, billing &

reconciliation, COBRA, 401k, & IT/HRIS environments.

Hands-on experience in new product development, implementation, & ongoing support of employee group health

& welfare programs for small group, middle market, & national account clients.

Creator of operational programs & enhanced processes to help drive a 30% growth in user lives on the BISNet

benefits administration platform during tenure with company 2005 -2008.

Extensive leadership of local & virtual teams for small private, large public, & pre-IPO employers with locations

across the US & overseas.

Significant recruiting, interviewing, & hiring of quality candidates using cost -effective sourcing methods.

Considerable experience blending company cultures & processes following merger & acquisition activity.

Successful guidance of cross-functional teams through 20 Fall Open Enrollment cycles supporting thousands of

group benefits clients & delivery of millions of carrier ID cards to subscribers/members.

Hands-on claim & call center leadership for one of Aetna’s largest group benefits clients (+160,000 members).

Strong service center management for 3,300-employee credit card retailer providing accurate responses to payroll,

benefits, retirement, & compensation questions from front-line staff to C-level executives, careful handling of

ERISA claim appeals, & primary liaison efforts with insurance carriers/vendors.

Key contributor establishing & staffing new West Region United Healthcare service center from ground up.

Exposure to a variety of regulatory requirements including Sarbanes -Oxley, HIPAA, ERISA, COBRA, LOA, DOL,

SAS70, etc., to support administration of a vast array of group insurance products such as PPO, POS, HMO, Life,

AD&D, Rx, Dental, Con sumer Directed & High Deductible Health Plans, etc.

Effective motivator of individuals as evidenced by numerous recognition nominations/awards & documented

“worst-to-first” operational success stories across multiple employers.

PROFESSIONAL EXPERIENCE

ClearBenefits/BISNet, Inc., Santa Clara/San Ramon, California 2005-2009

Vice President, Operations

Personally sought as rehire by CEO & Sales VP after ClearBenefits acquired BISNet to meld organizations.

Led implementation, account management, plan set -up, data certification, eligibility/EDI, payroll, billing &

reconciliation, customer service, & COBRA teams located in the US & India .

Created & executed strategic solutions to address tactical operations issues & attempt to position company

favorably in the SaaS & web-based Benefits Administration market.

Senior Director, Implementation & Support Services

Operations leader directing client services, implementation, account management, plan set -up, data

certification, billing & reconciliation, & customer service/call center teams located throughout the US.

Introduced cost analysis tools & 50+ process enhancements significantly improving revenue/expense ratios.

Created real-time on-line management database to track functional assignmen ts, team member activity, &

employer status reporting for company’s book of business.

Sponsored business review of current benefits platform preparing for upgrade to next version.

Kaiser Foundation Health Plan, Inc., Oakland/Walnut Creek, California 2008

Director, National Case Installation

Led a team responsible for implementing new & renewing national account benefits clients.

Supported Kaiser’s entry into self-insured product market.

Increased team awareness of implementation timelines/tasks to improve accuracy of project management tools.

Developed modeling tools & strategies to accurately forecast staffing needs & eliminate regional inefficiencies.

Providian, Inc., Pleasanton, California 2004-2005

Employee Service Center Benefits Manager

Led service team ensuring accuracy & timeliness of vendor payments, payroll accounting, eligibility data

transmission, HR processes, ERISA claim appeals, PTO/Time reporting, employee requests for assistance, etc.

Contributed to the management of the company benefits program including enrollment processes & recurring

evaluation of benefits providers (cost, level of service, audits, etc.).

Supported compliance through frequent process testing & maintenance of thorough procedural documentation .

Washington Mutual 2005 purchase of Providian resulted in closure of service center.

Aetna, Inc., San Ramon, California 1999-2004

Plan Sponsor Services Manager

Process leader managing a team of professionals handling plan set -up, contract drafting, enrollment,

billing/invoicing, & plan implementation /administration for national a ccount Fortune 500 employers.

Partnered with business constituents creating & implementing strategies supporting group insurance products

eventually achieving status as the “subject matter expert go to team” within the company.

Successfully contributed to integr ation of multiple legacy companies allowing for sunsetting of redundant

system platforms & reduction of operating expense ratios.

Created multiple programs eventually emulated by other teams within the company (new hire mentoring &

training, client service & staffing ratio measurement, sold plan documentation, MS Access databases, etc.).

United Healthcare, San Francisco, California 1997-1999

Business Manager

Key senior team member & manager of managers strengthening customer relations, increasing profitability, &

improving business processes for the organization’s West Region (San Francisco) client operations center .

Pro-actively managed budgeting, hiring, training, compensation, development, & coaching of account

management (client services) & contract administration staff.

Significant contributor in ramp down of San Francisco ops center & creation of new Chico, California, site.

Aetna Life & Casualty 1989-1997

Aetna/US Healthcare, Division Manager, Oklahoma City, Oklahoma

Co-site lead responsible for 150-employee multi-million dollar claim & call center including P&L, resource

alignment, incoming paper & electronic claim management, internal audits, escalations, & call monitoring .

Improved processes to resolve plan sponsor concerns, anticipate claim/call trends, & achieve quality outcomes.

Aetna Health Plans, Implementation Manager, Walnut Creek, California

Project manager coordinating implementation of benefit programs for employer clients.

Managed activity of diverse constituent groups to deliver projects on time & within budget.

Aetna Health Plans, Plan Consultant, Walnut Creek, California

Plan set-up analyst establishing group life & health benefits & structure in on -line systems.

Reviewed sold plans for compliance, administrative feasibility, & cost -effectiveness.

EDUCATION & OTHER EXPERIENCE

San Diego State University, Bachelor of Arts Degree, Journalism (major), Public Administration (minor).

Health Insurance Association of America courses A, B, & C completed.

Prior work experience in business writing & marketing communications. Information available upon request.

REFERENCES

Available upon request.

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