Product Manager Senior
Resume:
KAREN M. BOLLINGER
**** ****** ***** ****** ****, IL 60097
PROFESSIONAL SUMMARY
A seasoned project/product manager and analyst who is responsible for evaluating and identifying customer/client requirements for application and claim adjudication systems. Consistently delivers business solutions for revenue growth. Accomplished transformation of claims adjudication system issues through a solutions driven team based on strategic business decisions based on management experience. Skills include:
Product/ Project Leadership Strategic Planning Cross Functional Project Teams
New Product Start-ups P&L Responsibility/Mgmt. Account Management Program Lean Six Sigma Support Team Growth and Development Data Procurement/Organization
PROFESSIONAL EXPERIENCE
CVS CAREMARK – Northbrook, IL 2006 to Present
A Fortune 500 company (6 of 500) who, through their unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. They are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers.
Clinical Senior Product Manager: (March 2017 to the Present)
Responsible for leading the adjudication application products Clinical Development Manager and Clinical Administration System Application (CASA) for myPBM ecosystem.
Grown my knowledge by leading clinical adjudication solutions such as the development of Smart PA,
Lead the coding for the COVID 19 tests and vaccinations from the early onset.
July 2021 entered myPBM ecosystem as the business product owner for the development of the Clinical Design Management portion of the application. Successful development of the application, before the product was permanently placed on hold in early 2023.
I transitioned to the new role of business Product Manager for the CASA application, which is responsible for automating and digitizing manual processes of UM Management Policies including Question Sets. Additional requirements include capturing manual process of collecting the data that leads to the policy creation.
Successful incorporation of Artificial Intelligence as a part of the build of the policy question sets as well as a complete overhaul of the original CASA application layout. These enhancements are scheduled for deployment in June 2024.
Coordinated Clinical program issues by being a high energy problem solver; using my creative mindset to identify potential core issues.
Successfully maintaining and enhancing the Benefits work instructions for UM Clinical Programs and Clinical Products
Cross team coordinator who works closely with other CVS teams to use knowledge to gain the most effective system setup.
Identifies where gaps in the existing process are to ensure that products aren’t released without being fully vetted.
Responsibilities with the Clinical Client Operations team allowed me to further exercise my Clinical knowledge from the projects I lead from the Client Operations team.
Adjudication Systems Advisor: (August 2013 through March 2017)
Charged with leading projects and cross functional teams in an automated production environment. Responsible for culminating a leadership role in a pharmacy benefit management industry to improve operational costs and revenue growth. Reports to Director – Benefit Center of Excellence
Development of the customized clinical program automation for the Wellmark health plan. Established internal process for maintaining these programs to transition the responsibilities to the internal Benefit Relationship Management team.
Project lead for implementation and enhancement of the Smart PA schedule. Identified all potential issues and ensured that test plans and workarounds were identified and completed prior to enhancement release date.
Developed new process for effectively managing accumulation issues that have arisen as a part of the client migration process. Lead manual coding process team to ensure errors are identified prior to implementation date.
Provided support during client migration process by using strong analytical skills, and effectively resolved defect issues by effectively creating and running SAS and SQL Queries
Provided partnership and support to the entire migration team by being a partnership builder with exceptional service focus on internal and external clients’ needs and expectations
Benefit Relationship Manager: (January 2009 through July 2013)
Responsible for leading client benefit changes for specific clients who have had benefit challenges, and service interruptions in the past. Ensure that by proper communication and documentation that their intent was captured per their expectations. Reported to Director – Client Benefits
Manage the implementation of client updates to current or future designs based on client intent.
Manage client’s expectations and council client based on benefit system capabilities and benefits previously implemented by the client.
Coordinate and manage benefit changes with internal partners by educating internal partners on system capabilities and how to effectively establish client intent.
Identify quality related issues surrounding client’s intent and business coding needs.
Interpret and communicate ways to improve quality as it relates to the client’s expectations and internal departments.
Document and manage responsibilities as they relate to migration of clients from current adjudication platform to new adjudication platform
Proactively participate and learn new processes and programs as well as provide communication and documentation of changes affecting all clients to my account teams.
Analytic Consultant: (October 2006 to January 2009)
Responsible for providing analytic support to Mid-Market Employer Accounts and designated National accounts. Responsible for training to Account Management for the automated Sales Tools models. Also was responsible for updating and enhancing the Mandatory Mail/Incentivized Refill Restriction and Co-pay Breakeven automated Sales Tools. Reported to Director – Analytic Consulting Systems.
Provide accurate, credible, and timely communication and analyses to account teams and clients.
Supply useful marketplace information and benefit design benchmarking to clients.
Uses appropriate data mining and reporting tools and provides reports in a readable and usable format with appropriate levels of detail.
Acquires and maintains knowledge of Caremark data warehouse, tools, and products; serves as expert resource for these to account teams.
TRUSTMARK INSURANCE COMPANY – Lake Forest, IL July 1995 to October 2006
Pharmacy Analyst: Responsible for pharmacy vendor maintenance and claim data manipulation and support. Responsible for contract pricing, rebates, plan set up and eligibility. Coordinated internal and external design process for Rxaminer database. (January 2006 to October 2006)
Provide recommendations when there are claim load balancing issues.
Perform cost benefit and analysis on potential and existing clinical programs.
Coordinate internal and external auditing of pharmacy benefit manager to review contract pricing, rebates, plan set-up, and eligibility.
Assisted with design, edits, and testing of newly created plan benefits (Rxaminer) database.
Enhance and continue to develop pharmacy benefit savings.
Project Manager (Benefits Division): Responsible for managing and enhancing team responsibilities as a part of the electronic claim adjudication process. Responsible for ensuring that all project requirements were met within project deadlines. (July 1995 -January 2006)
Business Matter Expert for ERISCO Claim Facts and Group Facts platforms, Expert System and CORE platforms.
Responsible for leading Benefits Division projects and direct liaison between Trustmark’s Business Divisions and Trustmark’s IT department.
Provide business analysis for Benefit division enhancements as well as technical support to the 12 COBOL/Java/AION programmers by creating documentation in the form of project plans and cost analysis, system requests and business requirements.
Identifying and providing analysis, documentation, and cost benefit for production issues.
EDUCATION
DeVry University – Bachelor of Science April 2014
Computer Information Systems/Database Management
University of Phoenix – Master degree Computer Information System In Progress
CERTIFICATIONS
Certified Scrum Master Scrum Alliance
SAFe Agilist 6 Scaled Agile
SAFe Product Owner/Product Manager Scaled Agile
Pharmacy Technician PCTB
TECHNICAL SKILLS
Application Skill Level Years of Experience
Microsoft Excel Advanced 20
Microsoft Word Advanced 20
Microsoft Project Intermediate 18
Microsoft PowerPoint Advanced 15
Microsoft Access Intermediate 8
Microsoft Visio Intermediate 8
SQL DB2 Queries Advanced 15
SAS/Enterprise Guide Intermediate 4
Microsoft Teams Intermediate 5
Salesforce Intermediate 10
RALLY Advanced 3
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