Customer Service Quality Assurance

Objective

Chief Operating Officer Chief Administration Officer

Executive VP Senior VP

OVERVIEW: Twenty-five year insurance leader with a proven track record of

results managing service and office operations, marketing, and

strategic initiatives with an eye toward improving turnaround

times, customer service, and lower operating costs.

AREAS OF EXPERTISE

Service Center Operations Sales and Strategic Marketing

Claims Processing Management Procurement / Vendor Management

Account Enrollment & Billing Management Enterprise Sourcing Strategy /

Implementation

Corporate Services/Facilities Business / Systems Integration

Management Management

LEADERSHIP STYLE

. Highly proficient in staff development, team building & creating

motivated workforce.

. Energetic, aggressive leadership & participative management style.

. Dedicated, results-oriented, metric-driven executive.

. Innovative change agent with strong interpersonal skills.

. Achieves practical & timely solutions to organizational challenges &

welcomes accountability.

. Strong entrepreneurial spirit.

. Builds collegial teamwork within organization.

. Personal satisfaction through contributing to success of others, the

organization, & beating competition.

EXPERIENCE

April 2011 - May 2014: Senior Vice President Operations TMG Health

Responsibilities:

> Service Center Operations, Claims, A/G, Enrollment, Billing, Client

Financial Services.

Market Scope:

TMG specializes in the Government Market and is a leading BPO

supporting MA, MAPD, PDP, Medicaid, Dual Eligible, and most recently

Medical Supplemental related to functions such as claims processing,

member and provider service, print and fulfillment, A/G, enrollment,

billing and

Client financial services.

Key Accomplishments:

. Delivered administrative expenses under budget for 3 consecutive

years.

. Performance level of agreements for all clients exceeded 98% for 3

consecutive years

. Initiated and directed a revised operations business model

separating production roles from that of support services which

provided clarity of roles and responsibilities, single points of

accountability and enhanced focus on key delivery drivers that

ultimately enabled achievement of business goals.

. Built a high performance management team based on teamwork and

collaboration.

Aug 2008 - April 2011: Consulting Operations Executive, Rembrandt Group

LLC

> Leveraged knowledge and experience as an Operations Executive to assist

corporations in all aspects of Operational Delivery Capabilities

resulting in administrative savings and improved service.

Mar 2002 - Apr 2008: Senior Vice President Operations, Carefirst Blue Cross

Blue Shield

Responsibilities:

> Claims, Customer Service, Account Implementation, Enrollment, Billing

and Receivables, Business Process Management, Vendor Management,

Business Systems Integration, Corporate Services, Facilities & Real

Estate.

Key accomplishments:

. 42% reduction in claims inventory.

. 38% reduction in interest penalty payments for claims processed beyond

30 days.

. 17% improvement to 98% in claims processed within 14 days.

. 66% improvement in Average Speed of Answer.

. 58% improvement in Abandonment Rate.

. 116% expansion in customer service hours of operations / 9.8%

reduction in full time equivalents.

. 15.4% reduction in administrative expense within Operations.

Increased productivity on contracts per FTE (24.4%), claims per FTE

(30.9%) and inquiries per FTE (66.3%).

. 12% improvement in service & 8% improvement in claims via Real Time

Customer Satisfaction Surveys.

. Turned around customer dissatisfaction to competitive advantage on all

four customer segments from 2005 to present.

. Reduced unit costs in claims (8.9%), service & enrollment (14.4%), &

billing (11.2%).

. Delivered on schedule and within budget the opening of a Service

Center at CareFirst's corporate headquarters, an operating center for

our Washington D.C. operations and complete renovation of several

satellite offices.

. Initiated, developed, implemented and deployed Vendor Management and

Business Process Management Organizational Capabilities at the

enterprise level at CareFirst.

Mar 2000 - Jan 2002: Executive Vice President of Operations, EB DIRECT.COM

. Established six regional office centers.

. Built infrastructure for National delivery capabilities and developed

operating model for strategic alliances.

. Pursued and established technology partnership.

. Implemented call center technology.

. Implemented CRM capabilities; automated e-mail management capabilities

and live chat function with white boarding and forms collaboration.

Mar 1999 - Aug 1999: Senior Vice President Operations, Oxford Health Plans,

Inc.

. Accountable for Claims, Customer Service, Enrollment, Billing,

Accounts Receivable, Front End Administration, e-Business, Special

Investigations and Fraud Unit, Quality Assurance and Technical

Training.

. Led the development/implementation of Internal Performance Metrics.

. Established oversight capability for e-Business.

. Strengthened internal infrastructure for Claims, Customer Service and

Administration of Enrollment, Billing and Accounts Receivable.

. Realized significant improvement in Claims Inventory & Aging; Average

Speed of Answer, Lost Call Percentage; Group Installation; Inventory &

Aging of Enrollment Transactions; and Accounts Receivables. Within

these key performance categories a minimum of 25% improvements were

obtained with the majority exceeding 50% improvements.

Jan 1997 - Mar 1999: Corporate Senior Vice President - Chief Operating

Officer, NYLCARE Health Plans, Inc.

. Accountable for Information Systems Technology; Administration; Claims

and Customer Service; Training; Quality Assurance; Internal Audit; and

Business Services Consulting. Additionally, as of July 15, 1998 I was

accountable for NYLCare Integration activity associated with Aetna's

acquisition.

. Led system conversion of Billing, Eligibility and Claims onto a single

platform (GEMS).

. Implemented the PPO contract for the State of Alaska effective 7/1/97.

. Instituted town meetings for all Operations to facilitate communication

and foster teamwork.

. Initiated and directed implementation of HMO Site Templates, including

but not limited to standardization of Quality Assurance and Training

Programs, various technology components, management reporting and

workflow.

. Refined corporate infrastructure to support end users through Operations

Support Services. Functions include training, quality assurance and

technical support.

. Realized operating efficiency within Claims, Administration and

Information Systems throughout 1997 and 1998. Resulted in reduction of

claims inventory, improved cycle times, customer service activities and

the stabilization of our Information Systems environment. 1998 Key

Performance Indicators were met/or exceeded in 18 of 20 categories while

improvement was realized in remaining two.

1980 - 1997: Blue Cross Blue Shield of NJ - Vice President, Operations

(1995 - 1997)

. Accountable for all the HMO and POS lines of business for the

organization as it related to claims, member services and membership.

Other functions, which I was accountable, include Training, Quality

Assurance, Internal Audit and Technical Services.

. 20% staff reduction while enrollment grew by approximately 20%.

. 20% - 70% reduction in inventories in all lines of business.

. 45% improvement in claims timeliness within 7 days.

. Approximately 50% improvement in Average Speed of Answer. Lost call

percentages also significantly improved.

. Implemented the POS contract for the State Health Benefit Program; the

Medicare Risk Program and the POS product for the Federal Employee's

Health Benefit Program.

1980 - 1997 Blue Cross Blue Shield of New Jersey - Held positions of

increasing responsibility

EDUCATION

Bachelor of Science, Business Administration, Trenton State College

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