Randal Hiester

**** ****** ****

Cocoa, FL ***** 321-***-****

ad0c7u@r.postjobfree.com

Director of Claims Administration /Quality Assurance & Process Improvement / Shared Services

High-level leader with dynamic vision and a track record of success in operations, quality program implementation, and process improvement in major corporate environments. More than 28 years of management/executive management experience in the private, public and government sectors. Excellent recruiter who builds and directs winning cross-functional teams. Ability to reduce operational costs, restructure the organization and implement profit-oriented policies. Created, groomed, and maintained complex quality and training programs as well as direct oversight of various production departments. Implemented savings in various production and operational environments.

Executive Management

Team Leadership

Strategic Planning & Analysis

Communication

Process Capability Studies

Lean Six Sigma Black Belt

Business Development

Process Improvement

Regulatory Compliance

Frequent Public Speaker

Lead Auditor

Client Relations

Vendor Relations

Work Force Management

Complex Problem Solving

PROFESSIONAL EXPERIENCE

Direct Mortgage Loans, Hunt Valley, MD January 2022 - Present Mortgage Loan Officer

• Develop relationships with realtors to work collaboratively for client benefit

• Take application, and approve/deny mortgage loans

• Follow up on entire loan process keeping clients up to date throughout the process

• Close loans on time or early making sure all deadlines are met

• Adhere to high ethical and mandated regulations of the banking, legislative and NMLS standards. Humana Inc, Louisville, KY May 2021 – March 2022

Director of Claims Quality Audit

• Responsible for 6 million members and their claims consisting of 45+ million claims annually

• Oversight of contract changes and impact on claim processing

• Oversight of subcontracted claims and that relationship HEALTH FIRST HEALTH PLANS, Rockledge, FL January 2017 – May 2021 Director of Claims Administration

Director of Quality & Process Improvement

Director Shared Services

Created quality program to accommodate more than a dozen areas of internal audit, complying with state and federal regulations.

Established training programs to accommodate the new hire and deployment training needs.

Standardized all health plan procedures in a central repository.

Directed business analysts working on health plan projects and process improvement initiatives.

Served as executive representative to the IDN for Policy and Procedure changes. Randal Hiester

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Seamlessly executed the concept of Operational Excellence.

Worked closely with all areas of Operations including Claims, CS, Enrollment, Work Force Management, Clinical and Pharmacy

Developed revenue and cost forecasts and established Key Performance Indicators for tracking.

Managed facilities including vendors, seating and department moves.

Responsible for numerous cost centers involving as much as $10MM budget

Meet all Claims timeliness and financial SLAs for the health plan CAPITAL BLUE CROSS, Harrisburg, PA June 2013 – January 2017 Director, Operations Improvement

Built a quality program to accommodate the operational areas of internal audit to comply with state and federal regulations and to measure member impact or potential impact.

Maintained and improved training programs and created structured curriculum.

Developed training and development program for all levels of employees.

Worked collaboratively with Work Force Management in Verint WFM tool and helped troubleshoot WFM escalations.

Facilitated weekly team strategy meeting to reinforce best practices.

Standardized desk-level procedures in a centralized knowledge repository. PENNSYLVANIA DEPARTMENT OF HEALTH, Harrisburg, PA March 2011 – June 2013 Quality Data Management

Documented the Commonwealth of Pennsylvania Department of Health’s critical measurement criteria to ascertain progress and compliance.

Process-mapped many of the key areas as it relates to CMS and the Department of Health.

Created non-existing quality program.

FRY COMMUNICATIONS INC., Mechanicsburg, PA May 1983 – September 2007 Production Quality Leader (Director)

Manager of Hand Bindery & Mailroom (production)

Managed production departments of the hand bindery and mailroom.

Worked in all major areas of operations.

Liaised for Sales and executive management with potential and existing customers.

Oversaw the quality of 16 production departments at five facilities affecting more than 2,000 associates.

Reported directly to the President and gained a seat on the executive committee.

Established the Quality Assurance program which did not exist and became instrumental in bringing new customers to Fry.

Comprehensive scheduling of more than 400 employees directly reporting to me

Responsible for multi-million-dollar customer product outcomes

Meet government timeliness with associated SLA penalties

Budgetary responsibility

Implemented a higher-level QA program than competitors. Randal Hiester

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EDUCATION & CREDENTIALS

Doctor of Theology, Golden State School of Theology, Stockton, CA Master of Counseling, Golden State School of Theology, Stockton, CA Kellogg’s Executive Management Training, Northwestern University, Evanston, IL CERTIFICATIONS AND TRAINING

Lean Six Sigma Black Belt

ISO9001 Certified Lead Auditor

Total Quality Management

Statistical Process Control

American Society for Quality

Government High Level Clearance

Certified Loan Officer

Member of NMLS

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