Customer Service Sales

John G. Belew

**** * ********** **** ****: 423-***-****

Phoenix, AZ 85085 *****@*******.***

PROFESSIONAL PROFILE

Operations executive who excels in leadership, process and workflow improvements,

automation, successful in both start-up and turn-around environments, and emphasizes strategic

focus on customer service. Specific expertise in:

Budgeting & Cost Benefit Transition Planning Management & Team

Analysis Building

System Conversion,

Business Continuity Planning Implementation Building Matrix Partners

Planning Support Resource Planning &

Strategic Planning Process Reengineering Employee Development

Customer Service Multi-site Management

Negotiation Mentoring and Coaching

Resources

PROFESSIONAL EXPERIENCE

Advantage Health Care Management Company 2012 - Current

VP Claims

Phoenix, AZ (June 2012 - Current)

• Responsible for claims processing, member services, and Grievance and Appeals

departments. Provide leadership, vision, and direction to the departments to ensure teams

meet all regulatory and corporate goals. Accountable for quality control management and

technical oversight of all claim operations assuring compliance with internal and external

requirements. Define, monitor, and measure operational effectiveness and opportunities.

Work on a cross functional basis to resolve and remediate operational issues. Drive process

improvements. Partners with leaders of the organization to achieve strategic initiatives.

Product lines supported…Medicaid, Medicare, and Commercial. Budget $6.2 million.

o Quickly identified inventory and TAT deficiency in mandated requirements. Led

efforts to remediate the situation and did so in under 2 months.

o Led efforts in reviewing auto-adjudication inhibitors and modified as possible

o Led efforts in utilizing automated system tools to handle adjustments and

reprocessing.

o Led integration efforts of new business impacting claims, member services and G&A

o Led efforts in opening up communication and development of staff

o Led efforts in building cross functional partnerships to help drive change and

increase efficiencies

Blue Cross Blue Shield – TN 2011 to 2011

Director of Research and Development, Medical Informatics

Chattanooga, TN (May 2011 – October 2011)

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John G. Belew

• Responsible for the research, development, consultative function regarding the system, tools,

and methodological support of the Medical Informatics Dept. Provides the technical and

analytic support solutions of the department’s work and ensuring the necessary system and

service support to meet the needs of both internal and external customers.

Multiplan/Viant 2008 to 2010

Regional Vice President of Network Operations

Chattanooga, TN (May 2008 – Oct 2010)

• Responsible for Claim processing and Provider Data management. Processing occurring in 3

sites – Lake Forest, CA, Chattanooga, TN, and Naperville, IL. Responsible for offshore

claim and provider data processing initiatives, driving efficient data entry process, inventory

management, and performance metric reporting. Ensure timely and accurate pricing of claims

and entry of provider related data.

o Led performance initiatives in creating and streamlining workflows, implementing

new front end entry systems, development of management and tracking reports,

development of P&Ps, and creation of training material.

• Budget of $7.8 million.

Centene Corporation, Great Falls, MT 2001 to 2008

Vice President of Claim Operations

Promoted from Director of Claim Operations in 2003 as a result of the continuing strong operational

performance of the Farmington Claim Center.

Great Falls, MT (October ’04 – May 2008)

• Responsible for building and managing a new claim operations center. Staffing level at 102 FTE.

Work in conjunction with the Farmington claim operation to ensure timely and accurate medical

claim processing. Oversee budget of $4 million. Led efforts to secure state training dollars.

• Build and cultivate relationships in the community.

Farmington, MO (September ’01 – October ’04)

• Managed the daily operations of the Claims Department and ensured timely and accurate medical

Medicaid claim processing. Oversaw budget of $7 million; average of 150 employees; service to

783,854 members.

• In 2001 to 2003, realized 117% growth in membership and 193% growth in receipts while

controlling production costs through a staff increase of only 29%.

• In 2001 to 2003, achieved 76% drop in average days receipt to paid (5.7 days) and 144% decrease

in average pended volume. Provided consistent and above standard turn around time in claim

processing. Led site performance improvement initiatives by building the management

infrastructure, development of improved work processes, P&Ps, clear communication, and

setting of expectations. Led implementation of new front-end data entry, scanning, (Macess) and

mailroom technology for processing incoming mail. Partnered with HR in developing job

progression levels for staff.

CIGNA, Chattanooga, TN 1994 to 2001

Senior Regional Director (1999 to 2001)

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John G. Belew

Responsible for the Chattanooga, TN, and Bristol, TN, indemnity and PPO medical claim operations.

Oversaw budget of $21 million with an average of 610 employees servicing 1.3 million members.

Processed an average of 860,000 claims per month.

• Participated and partnered with sales team on new sales and problem management.

• Senior lead for the following projects: appeals/grievances, business continuity plans, employee

incentive program, confidentiality, eligibility, history loads, HR projects (employee opinion

survey action plans, employee suggestions, quarterly employee review), provider relations,

overpayment recovery, standardization committee, and various transformation related

committees.

Regional Claim Director (1994 to 1999)

Responsible for the Chattanooga, TN, indemnity and PPO medical claim operation. Oversaw budget of

$12 million with an average of 235 employees providing service to 191,400 members (481,900 at the end

of 1999). Processed an average of 187,000 claims per month.

• Took office through tremendous growth period from 1998-1999. Membership increased 152% to

481,900; claim volume increased 75% to 3.4 million new receipts. Participated with sales team

on new sales.

Health Data Analysis Consultant (1994)

Developed systems and programs that utilized data from the claim payment system to produce the reports

necessary for resources to meet with the customers to advise them on the performance of their benefit

plans.

CIGNA, Columbia, SC (Healthsource – Provident) 1993 to 1994

Regional Claim Director

Responsible for the Columbia, SC, indemnity and PPO claim operation. Oversaw budget of $2.6 million

with an average of 65 employees providing service to 65 accounts.

Provident Life and Accident, Chattanooga, TN 1986 to 1993

Project Leader (1992 to 1993)

Systems Analyst (1989 to 1992)

Senior Programmer (1987 to 1989)

Programmer (1986 to 1987)

Supported various claim payment applications and software including eligibility verification, claim

selection, LTD, Accident & Sickness, and medical claim payment systems.

Halliburton Services, Duncan, OK 1985 to 1986

Programmer/Analyst (1986)

Associate Programmer (1985 to 1986)

EDUCATION

B.S.B.A. Accounting/Data Processing, University of Arkansas – Fayetteville, AR

HONORS/ACTIVITIES

Member, Military Affairs Committee and Executive Board (Chamber of Commerce Great Falls, MT)

Member, Industrial Development Association (Farmington, MO)

Member, Workforce Investment Board Missouri

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John G. Belew

President, Doe Run Baseball Association

Chairman, Board of Directors, Provident Credit Union

Board of Directors, Provident Credit Union

President, Provident Club Council

Golden Key National Honor Society

Member, Sigma Alpha Epsilon

Member, Phi Beta Lambda

Member, Computer Club

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