Manager Service

John M. Dembowski

978-***-**** ª 978-***-**** ª ******@***.*** ª http://www.linkedin.com/in/johndembowski12

Service Improvement and Operations Leader

Extensive business operations and service experience within customer facing, highly competitive markets. Analytical strategist skilled in successfully leading vendors and service departments through periods of sustainable growth and challenging transitions. Collaborative communicator continually focused on building relationships and promoting synergy across business lines. Proven track record of implementing new processes that advance organizational initiatives or create revenue opportunities.

Areas of Expertise

National Service Operations Critical Thinking and Problem Solving Operational Alignment

Call Center Administration Root Cause Analysis and Reporting Implement New Initiatives

Cycle Time Improvement Project Administration Escalated Issue Resolution

Experience

HEALTH PLANS INC. – Westborough, MA 2019-2020

Claims Operations Manager

Provide support and direction to a group of supervisors and senior examiners in the day to day operations of the claim department while supporting the Director of Claims with escalated items, ongoing and new projects. Monitor block of claims to keep KPI’s in goal. Responsible for new hire reviews and vetting applicants.

TUFTS ASSOCIATED HEALTH PLANS – Watertown, MA 2018 - 2019

Claims Manager - Public Plans

Oversight of Supervisors and their direct reports of approximately 40 Processors in the timely and accurate processing of claims within production standards. Work closely with Provider Management, Member Service and Enrollment in addressing issues and appeals on claims. Vendor relationships and processing according to contract agreements.

Completed vendor Implementation within first 3 months of employment to manage our collections, COB and TPL processes.

Monitored the daily counts keeping aging and state requirements in line, answering appeals or DOI issues.

Utilized and developed reporting with programmers to utilize data to help drive resources, department needs and identify issues that may be out liars.

Completed Employee Performance Assessments and contributed to budget allocation of increases.

Implemented Interview process of Temp Employees to assure position understanding and assure cultural and positional fit as many temporary employees may be considered for full time hires.

TRUSTMARK INSURANCE COMPANY · Worcester, MA 2005 – 2017

Director of Claims and Service – Voluntary Worksite Benefits 2012 – 2017

Ensure that department KPI’s in all units are met daily, including time sensitive handling and administrative functions. Procure, monitor and engage with onshore and offshore vendors to confirm they are meeting targets. Emphasize financial and procedural accuracy in department functions, with compliance to company and state regulatory guidelines.

40% reduction of inventory using Root Cause Analysis to escalate handling of claims the same day as receipt.

Oversee Vendor relationship on outsourced processing to meet or exceed standards as agreed upon in contract.

Led the implementation of a Private Label workflow to manage all phases of product handling for claims.

Reduced cycle time by 37% with the development of an accelerated claim methodology focused on alternative proof of loss, prioritization of claims and proactive triage.

Participate and/or drive company projects as directed. Construct staffing models to confirm proper employee utilization.

Direct review and signoff of payment or denials of all assigned claim lines of business including STD/LTD, Life, Accident, Wellness, Cancer and Critical Illness, ensuring accurate, timely and professional handling.

Created and implemented customer surveys that deliver critical response data on service experiences and employee interactions. Met or exceeded target goals of survey results monthly for communication, professionalism, knowledge, helpfulness, or recommend to coworker or family member.

Drive employee production through use of Key Performance Indicators tied to SMART goals based on company objectives.

Contributed to and co-patented the creation of new Critical Illness products, Critical Life Events, which was regarded as the most innovative product to enter the market and boosted business development opportunities.

Devise process improvements based on root cause analysis of service and financial concerns impacting customers.

Collaborated with external Brokers and Sales force in response to all customer or employer inquiries.

Associate Director 2007 – 2012

Oversaw the transition of business blocks from Illinois to Massachusetts with negligible service disruption. Managed the talent acquisition process for new business areas via open house.

Reinforced departmental adherence to policy interpretations and standards to build best practices, reduce legal risks, identify service trends and satisfy all contractual obligations.

Initiated systems solutions with the Project Team that automatically pay benefits based on customer payroll frequency.

Senior Claims Consultant II, Manager 2005 – 2007

Steered employee operations with strict dedication and education on aggressive performance metrics, integrity and judgement when adjudicating claims.

ADDITIONAL RELEVANT EXPERIENCE

HANOVER INSURANCE GROUP · Worcester, MA 2000 - 2005

National Director – Billing and Service Operations

National responsibilities in directing and managing all aspects of department operations, including metrics and operational/financial reporting, prioritization of technology initiatives, driving process improvements/change, audit management, and accountability for department budget of $8.0M, and $2.5B in receivables.

Developed and implemented metrics and reporting process to track and monitor key operational goals.

Prioritized and drove all Technology enhancements in support of key departmental and corporate priorities.

Managed 5 Senior Managers, vendor relationships including lock box, collection agencies, and cash management.

Strategic Operations Manager – Agency Accounting, Retail, Commissions and Payroll Deduct Billing Operations

UNUM Companies Inc. 1988 - 2000

Billing Operations Manager – Reinsurance Consultant – Claims Consultant

EDUCATION

BACHELOR OF SCIENCE, COMMUNICATIONS/MEDIA FITCHBURG STATE UNIVERSITY Fitchburg, MA

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