Hayward Campbell II

Compliance Analyst

Professional Experience

IAT Group Sep 2013- Apr 2016

Business System Analyst, IT Department

Determines operational objectives by studying business functions; gathering information; evaluating output requirements and formats.

Designs new computer programs by analyzing requirements; constructing workflow charts and diagrams; studying and testing system capabilities; writing specifications.

Monitors project progress by tracking activity; resolving problems; publishing progress reports; recommending actions.

Handled cyber security, checked for user accounts and did system testing as well

Provides references for users by writing and maintaining user documentation; providing help desk support; training users.

Performs company 1099 Tax Reporting by gathering date, formatting, verifying and preparing final submittal format to IRS

Subject Matter Expert in System upgrade of Original Software TestBench / TestDrive, ensuring all pre-requisites were met from current system installs, current service pack, to all users’ laptops had the correct conversion pack installed.

Set up and disable Users in the AS400 system provide audit and compliance checks of users’ system requirements & access for role.

Perform audits of Claims, processed and in process before payment, along with developed 2 reports to assist management in monthly review.

Blue Cross Blue Shield Oct 2011-Mar 2013

Compliance Consultant, Appeals

Ensured compliance with existing laws, regulations and requirements.

Researched, investigated, and evaluated compliance implementation initiatives and required remediation initiatives.

Conducted risk assessments and audits and monitor department/divisional systems for compliance. Ensured appropriate implementation and corrective action was taken to address risks and issues identified in partnership with Corporate Compliance.

Analyzed and assessed departmental environment and compliance program and system needs. Recommended compliance programming and compliance initiatives in consultation with Corporate Compliance

Redesigned and Managed Appeal Department SharePoint Redesign Project to improve tracking and updating of Job aides, procedures and information. The project made the SharePoint a training aide for new hires and cross training of analysts.

Facilitated Monthly Meetings and Workgroup meetings: Appeals Department SharePoint Workgroup, Appeal Department/ InterPlan Programs JOC meetings, including representing Provider Appeals Department in Company QIC meetings and project meetings.

Blue Cross Blue Shield Jan 2009-Oct 2011

Quality Auditor, Claims Review – Training - Policy

Performed weekly and monthly departmental audits.

Performed Focus Audits of system and customer service representative processes.

Performed SAS70 High Dollar Audits that reviewed Financial Risks and ensured Financial Accuracy.

Reported Audit Findings and Trends to Management through Database Storage and Weekly Reporting.

Developed Couching Clinics that addressed and educated customer service representatives of audit findings and correct operational procedures and processes.

Blue Cross Blue Shield Oct 2007-Jan 2009

Compliance Specialist, Regulatory Compliance

Selected for Special Project to assist with Thomas Love Litigation review of organizational policies, laws and regulations.

Supported Director of Compliance with implementation of high ethical and compliance standards and assured regulatory compliance at BCBSNC through audit programs and projects.

Managed5complex, highly visible cross-functional projects to ensure compliance with new and existing laws and regulations.

Assisted with deployment of corporate compliance programs through training, audits and assessments, investigations, NCDOI examination support and legislative implementations.

Identified compliance risks throughout the company through internal mock audits, reviewing and analyzing findings while documenting company processes and procedures.

Worked on compliance team in the development and implementation of corrective action plans to be review and signed by executive management for company approval during annual reviews.

Conducted internal audits and compliance reviews in order to mitigate risks related to regulatory audits performed by state regulators and third party vendors.

Blue Cross Blue Shield May 2006-Oct 2007

Business Analyst, InterPlan Programs Compliance

Managed resolution of Compliance issues/projects that resulted in process improvements and business efficiencies.

Conducted and disseminated policies to support Inter Plan Programs business.

Developed target standards and timelines to in accordance with unit, departmental and divisional goals.

Conducted AS IS, gap, and lean assessments of InterPlan Operation that resulted in process improvements.

Prepared business cases, business requirements, root cause analysis, and risk assessment & controls evaluations on BCBSA, Corporate, and Operational Excellence projects.

Prepared management and executive compliance reports.

Led InterPlan Program SAS-70 Claims Balancing Project- ensured accurate reporting, explanation of claim systems data, and risk mitigation through group walkthrough meetings, which included system overviews, review of control matrixes in place, alone with audit review sessions with external vendor, PWC. Prepared and submit Final SAS-70 report for department.

Served as an Advocate and Liaison for InterPlan Operation end-user requirements and ensured project implementations met business need.

Served as Business Liaison with Project Managers and communicated progress reports to business.

Blue Cross Blue Shield Jul 2004-May 2006

Interim Team Lead, InterPlan Operation

Operation Specialist, InterPlan Operation

Managed daily workflow to achieve index goals. Took appropriate actions to follow through on open inventory.

Handled customer inquiries regarding claims, membership, billing, and other issues. Researched and responded promptly, courteously, and thoroughly to all inquiries.

Identified quality issues and training needs for InterPlan Programs.

Designed and implemented training course for new employees. Identified, documented and escalated system and process problems. Thoroughly analyzed issues, determined root cause and recommended remediation to business.

Provided feedback for operation improvement on human errors to associates.

Processed all phases of claims adjustments to reflect appropriate certificate liability.

Reduced aged inventory, escalated calls and issues from, other Blue Cross Plans and InterPlan Operation.

Dedicated representative for Duke University Medical Center to resolve their concerns & issues with outstanding Blue Card out-of-state claims.

Blue Cross Blue Shield Jan 2002-Jul 2004

Tech Support, Blue Card

Customer Service Representative - Blue Card Host, Blue Card

Liaison between Medical Provider and Patient’s Home Plan.

Provided exemplary customer service on inbound provider calls.

Processed medical claims submitted by providers

Subject Matter Expert resource to associates regarding complex calls, irate calls, and substituted for supervisor regarding call management.

Midway Airlines, Inc. 1998-2002

HUB Operational Manager

Ticket Counter Supervisor/ Gate Agent Supervisor, Midway

Managed staff of 26 ticket counter agents.

Managed staff of 150+ gate agents.

Resolved escalated customer service ticketing issues.

Managed extensive daily flight operation schedules at Raleigh Durham International Airport.

Made management decisions for Air Traffic Control and weather delay aircrafts’ departures.

Reported on safety checks regarding the airplane flight readiness.

Implemented training course for new hires.

Performed Ground Security Representative Duties at RDU Airport.

Compliant Resolution Official at RDU Airport

Marketing Support Representative, Midway

Designated to support Platinum clients.

Conducted problem resolution, priority waitlist clearance, and issued ticketing waivers.

Primary Liaison with Northeast and Southwest Regional Sales Directors.

First-line responder for issues originating from Area Sales Managers regions in lieu of Director.

Education

2006 Mount Olive College RTP Location

B.S. in Management Organizational Development Program.

2017 Pfeiffer University Misenheimer, NC

Master of Business Administration

Master of Health Administration

Skills

Visio

ENVISION: Enterprise Risk Management

Green Belt Training

Introduction to LEAN

Use Cases

Data Analysis 101

ACL

Leadership Development at BCBSNC

BCBSNC Business Writing Essentials

Privacy Coordinator

SAS Programming

SAS Programming II

SAS Visual Analytics Introduction

SAS Visual Analytics Certification Prep

Microsoft SQL Server Introduction

Activities / Awards

United Way Ambassador

Career Styles Ambassador

African American Black Employee Network (AABEN)

Professional Development Committee

Community Service Committee

African American Leadership Institute

2009 Steering Committee

2010 Steering Committee

Blue All Star(s)

Spot Award(s)

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