Craig J. Ardagh

**** ******* ***** - ******* *****, ILLINOIS 60089

Home: 847-***-****/Cell: 847-***-****

email: ac8gxa@r.postjobfree.com

SUMMARY

Multi-tasking, results-oriented professional with experience in the Insurance Industry. Effective team leader looking for a position to leverage my leadership and technical knowledge in regulatory compliance processes, reporting and operational risk management. Proven ability to manage mult-state projects and recognized for the ability to manage efficient and productive workplace environments with exceptional levels of cross-functional interface and team communications.

PROFESSIONAL WORK EXPERIENCE

BC/BS of Illinois, Chicago, IL, Feb 2018 to July 2018, Medicaid Operations Manager

Team manager for Provider Portal and Member Complaints. Coordinate resolution of Appeals and Grievances and claims adjustments/and over-payment recoupments. Includes responsibility for all ad-hoc reporting to regulatory agencies. Have accomplished meeting all timelines set forth by state agencies in reporting.

AETNA BETTER HEALTH of IL, CHICAGO, IL Aug-2016 to Feb-2018, Sr. Compliance Lead

Provide and manage all compliance and regulatory affairs activities for Aetna's IL Medicaid and Medicare programs. This position’s accountabilities includethe following:

All operational risk assessments,

specialty product filings;

Periodic and ad-hoc reports to state and federal agencies including CMS.

This position also has active management of continual development of a robust, Provider Network Management, Provider Credentialing, Grievance and Appeals, Fraud, Waste and Abuse prevention plans on behalf of the IL Aetna Better Health Plan. It’s notable that in my capacity I've been able to manage timely reporting at 99% satisfaction level including substantial Plan improvements that maintain regulatory standards.

INDEPENDENT REGULATORY CONSULTANT, 2015-2016, Chicago, IL

Provided regulatory consultancy by reviewing of general advertising and agent letters for use by independent life insurance agencies contracted and licensed by Sammons Financial Inc.

BCS FINANCIAL INCORPORATED – Chicago, IL APR 2012 – DEC 2014 / AUG 1997 – AUG 2001

Sr. Compliance Analyst

Responsible for reviewing and interpreting pertinent insurance-related regulations including all related form, rates and rules regarding Health .Accident and Commercial Property & Casualty products.

Thorough understanding of industry data bases such as ISOnet, Oden, PCI and state DOI web sites.

Implemented all compliance including rate, rule and form submissions to regulatory agencies via SERFF and I-file systems with high approval rate when including effective response and negotiation processes to Department of Insurance objections..

• Lines of business: Group Self-funded Stop Loss, Ancillary, Accident and Health Products, D & O (Management Liability), EPL, Fiduciary Liability, Professional Liability, Inland Marine/Commercial Property, Commercial Auto, General Liability, Worker’s Compensation/Employer’s Liability, Cyber /Privacy Liability. . Have detailed understanding of all bureau supported lines of business and all experience and annual statement reporting requirements both externally and internally including statistic reporting to industry level insurance information bureaus.

Initialed design and implementation of Casualty program for specialty classes of business utilizing ISO insurance bureau-based forms and loss costs with application of company’s LCM . Accomplished state approvals where normally such approvals were not easily granted (i.e.; TX and VA) for these general liability and inland marine classes of business

Core competency level exemplified by being results focused with demonstrated self-initiative in a consistent manner, technical expertise including effective use of Microsoft Office Suite, presentation skills and constant pursuit of industry knowledge on an informal and formal basis.

C&N INSURANCE CONSULTANTS – Buffalo Grove, IL DEC 2010 – APR 2012

Owner/Operator

Performed agency operations providing personal property and casualty, small group and individual benefits. Primary focus on health, accident and health including life benefits.

DEPARTMENT OF DEFENSE – Des Plaines, IL JAN 2010 – NOV 2010

Chicago Area Coordinator - Contractor

Executed daily management of Department of Defense aptitude assessments of prospective military positions by coordinating, administering and programming of automated examinations in the Chicago Region.

Managed and maintained regional school databases for efficient implementation of school-based examinations.

INSURANCE INFORMATION TECHNOLOGIES INC. – Warrenville, IL JUN 2008 – JUN 2009

Business Analyst & Client Services Representative

Designed, assessed and maintained client requirements and rating software platform per client specifications as needed for all commercial lines of business product administration systems.

Planned and executed all regression and test plans for monthly releases.

Maintained oversight and maintenance of the bureau’s rates/loss costs, forms and rules revision via utilization of databases affecting client’s business processing.

Improved efficiencies and client relations by 20% with notable client relationships with Liberty Mutual Insurance Company and Lockton Risk Affinity Services.

RON RUBENSTEIN CPA LTD. – Buffalo Grove, IL JUL 1997 – JUL 2012

Seasonal Accounting Services/Personal Tax Consultant

Provided general journal bookkeeping services for firm’s clients.

Management accounting as assigned and personal tax services during tax filing season.

INDEPENDENT CONSULTANT – Buffalo Grove, IL AUG 2007 – MAY 2008

Provided consultancy to various insurance firms including services for product, rate and or rule regulations and submissions to industry’s electronic platforms.

AON RISK SERVICES INCORPORATED – Glenview, IL AUG 2001 – JUL 2007

Senior Client Specialist/Team Leader-Policy Maintenance

Team leader of the risk management and quality control of the renewal/proposal process including processing certificates of insurance and mid-term endorsements for fully automated commercial lines.

Assisted in maintenance of updating company databases as required to include comprehensive review of client’s policy portfolio.

Project leader of a task force strategy/process committee for the continual development and improvement of project flows and quality initiatives. As a result of improved efficiencies received Employee STAR Award, 1st quarter, 2005.

Responsible for Midwest and West Aon Offices.

PROFESSIONAL AFFILIATION/ACHIEVEMENTS

Fellow, Life Management Institute (FLMI), Conferred on 5/2002

AHIP Certified, 2016-2017

Associate in Insurance Regulation and Compliance (AIRC) Conferred on 5/2000

Certified Compliance Professional (CCP), Conferred on 10/2000

Pursuing Chartered Property & Casualty Underwriter (CPCU) - Passed 7 of 8 exams.

Volunteer for Wounded Warriors Program, North Chicago VA Hospital

Currently hold Illinois Producer License

Software knowledge, Microsoft Word, Excel, Powerpoint, Salesforce and Sharepoint Applcations

EDUCATION

M.B.A., 05’ (Healthcare Finance)- Lake Forest Graduate School of Mgt. Lk Forest, IL

B.S. in Marketing - Southern IL University, Carbondale, IL

A.S. in Applied Science- Community College of the United States Air Force

MILITARY EXPERIENCE

UNITED STATES AIR FORCE / UNITED STATES AIR FORCE RESERVE

Honorable Discharge/Retired 2007

Rank – Master Sergeant

Presidential Appreciation Citation – 2007

Meritorious Service Medal - 2007

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