Sr. Director, Vice President

~ QUALIFICATIONS PROFILE ~

- Highly-experienced, team-oriented, and results-focused management professional, strongly inclined to obtain an executive level position that would effectively utilize and enhance more than 20 years of exceptional experience in operations management and technical service within the health care industry

- Proven expertise in developing and implementing effective strategies and solutions to improve efficiency, quality, and customer service

- Highly effective leader, with in-depth knowledge of management principles involved in strategic planning and leadership technique

- Demonstrated ability to coordinate training programs and develop plans for optimum improvement; able to supervise and guide individuals and groups in the fulfillment of company goals

- Possesses collaborative communication style, with proven ability to establish effective and productive relationships based on knowledge, professionalism, and integrity

PROFESSIONAL EXPERIENCE

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HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY - Newark, NJ - 1989-PRESENT

DIRECTOR, SERVICE OPERATIONS 2005-PRESENT

- Direct overall functional areas of Facility Operations Customer Service and Account Reconciliation Department

- Oversee operations in processing of more than 2.6 million claims and over $7 billion in annual payments

- Supervise customer contact activity for more than 1,000 facilities with annual call volume of approximately 2 million

- Ensure compliance with Federal and State regulations in managing account reconciliation and inquiry processing activity

- Effectively apply strong leadership skills in overseeing activities and performance of managers and team leaders in department consisting of 180 FTEs

- Administer and allocate operations annual budget of $16 million

- Identify and implement process improvement initiatives through maximization of people, process and technology

- Provide strategic direction for team to deliver quality service while focusing on cost containment activities

Key Accomplishments:

- Provided exceptional performance in optimizing Hospital Satisfaction results within single year

- Successfully executed process improvement initiatives to reduce inventory and meet all World-Class goals

- Played pivotal role in implementation of innovative customer service model partnerships with collocation of staff to client sites

- Achieved highest employee satisfaction scores in division at 85 percent

MANAGER, OPERATIONS 2002-2005

- Efficiently oversaw all aspects of HMO, Medicare Blue, Point of Service / Direct Access, Medigap Operations including Claims Processing, and ACD call center in accordance with Federal / State regulations

- Applied strong leadership skills in managing five Team Leaders, two Team Leader Trainees and one Business Support Analyst

- Coordinated activities of business teams consisting of 100 FTEs and monitored claims inventories as well as customer service activity; ensured all CMS, BCBS Association, Performance Guarantee and Enterprise goals are achieved consistently

- Represented Service Division on enterprise workgroups and cross-functional work teams

Key Accomplishments:

- Successfully achieved World Class performance measures goals

- Ranked #1 in Customer Service on State Report Card

- Analyzed and identified significant claim inventory reduction, claim reduction of more than 100,000, and inquiry reduction of more than 20,000

- Directed operational system migration for major lines of business

TEAM LEADER, MEDICARE BLUE OPERATIONS 2000-2002

- Engaged in human resources functions including hiring, training, and developing claims processing and customer service staff

- Directed offshore vendor processing activities to ensure integrity and optimum performance

- Efficiently handled claim inventories and phone volumes in accordance with CMS, BCBS Association and Enterprise goals

- Represented Medicare Blue Operations department on enterprise workgroups and cross-functional work teams such as Medicare Blue Product Development and Senior Market Strategy

Key Accomplishments:

- Dramatically reduced claim inventory by 30,000 claims in six month period as well as unit ASA from 230 seconds to 30 seconds in six month period

- Directed unit Encounter Data project that resulted in substantial financial increase

- Achieved CMS Claims processing timeliness goals for both 30 and 60 day standards

MANAGER, SENIOR MARKET ADMINISTRATION 1995-2000

- Facilitated technical, quality and training support for all users of Trizetto processing platforms within Indemnity and HMO lines of business

- Directed all systems’ activities including file maintenance, system change definition, testing implementation, benefit file loading and production support

- Oversaw all electronic transmissions for both claims processing and premium processing with other insurers and lock box vendors

- Supervised presentation of all formalized training classes on operational and systemic initiatives

Key Accomplishments:

- Functioned as Project leader for installation of Y2K compliant software for the Claim facts and Group facts systems; received commendations from Senior Management for outstanding job performance

- Directed successful implementation of Medicare Blue billing process on Group facts system which successfully processed quarterly bills for additional 40,000 members

- Served as Project Leader for claims outsourcing initiative; coordinated process of outsourcing claims processing function to outside vendor

- Played integral part in design and development of specifications for recovery, trained and supervised recovery team; completed project ahead of schedule and generated recovery amount of more than $ 2.5 million

- Successfully streamlined Medicare Blue enrollment quality program due to system conversions

- Spearheaded implementation of electronic crossover arrangement with Medicare Part A

- Effectively worked as project leader for all cash lockbox vendors including First Union and PNC bank; oversaw all file transmission and account reconciliation activity for annual premium of over $ 240 million

OTHER EXPERIENCE

HORIZON BLUE CROSS CLUE SHIELD OF NEW JERSEY - Newark, NJ

Team Leader, Medicare Operations - 1993-1995

Training Coordinator - 1993

Technical Analyst - 1989-1993

NATIONAL PRESCRIPTIONS ADMINISTRATORS (NPA) - Clifton, NJ

Supervisor, Vision Department - 1987-1989

EDUCATION

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BACHELOR OF ARTS IN SOCIOLOGY WITH MINOR IN BUSINESS

Mount St. Mary’s College - Emmetsburg, MD

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