Jim Delaware Email & Phone Number

Portsmouth, New Hampshire, United States

Strategize the planning and development of PCG TPA (third party administrator) with internal and external customers.Manage team responsible for all EDI/System functions: * Production cycle * Eligibility loads * Check Run Process * 837 Claims Loads * 835 Payment Files * System Configuration * Void and Reissue checksWork closely with Project Managers who will prioritize and oversee project advancement.Conduct due diligence of internal TPA/client workflows and recommend efficiencies and improvements with clients and vendors.Provide governance for submission of service tickets with vendors.Develops and implements procedures pertinent to the effective and efficient operations of all departments.Coordinate development of IT technical initiatives with PCG Operations Teams, clients, and vendors.Lead development of new platforms and interfaces with clients and vendors.Provide analysis of customer issues and ensure effective and long-term problem resolution.Main TPA operational contact and lead development of infrastructure with business partners.

Woburn, Ma

Regional Operations Manager for Northeast Region in charge of client support and project management covering clients in the Northeast region. • Work collaboratively with internal teams (Product, Development, IT, Claims, EDI, Account Partnership, Provider Relations, Compliance, Legal, Audit, Reporting..), as well as clients in the Northeast, assuming overall ownership and accountability of Project success, which includes (but are not limited to): Project Definition, Resourcing, Tasking, Budgeting, Conflict Resolution and Driving projects to a successful conclusions.• Manage projects in a proactive fashion to be ready for the inevitable changes and challenges, and pivot as internal and external conditions dictate.• Clone project team resources via cross-training and shadowing (i.e. having a back-up for each team resource, ensuring projects don’t stall due to primary resource not being available). • Excellent client reviews on all client projects managed and issues handled, for both response time and results delivered.

Led the Client Production Operations & Customer Support department, encompassing 3 teams: Production Operations, Production QA and Customer Support. •Accountable for all aspects of production customer support for three of McKesson’s SaaS solutions.•Led overall strategic approach to customer issue resolution. At a high-level this consisted of: (Stop-Bleeding, Short-term Solution, Root Cause Analysis, Design & Develop & Implement long-term solution with a goal of future prevention). •Main operational liaison between Clients, Production, Support, Client Services, Product, Analytics, R&D and DevOps, to ensure production client satisfaction and drive E2E operational efficiencies to meet/beat client SLAs, as well as overall business needs for today and tomorrow.•Ensured timely and accurate execution of entire production data refresh cycle of McKesson’s population health SaaS solutions, as well as the associated customer support for these solutions.•Created, implemented and enforced internal & external SLAs and SOPs.•Responsible for team building, development/growth, performance management and sustainability.•Led client-facing meetings to address difficult/complex items as they arose. I also, led month scheduled “Health Check” meetings with strategic production clients to ensure we were meeting, or better yet - beating standing SLAs, as well as to ensure any current issues and/or questions were being addressed to the clients’ satisfaction. Worked closely with AEs, PMs, Product and R&D in representing the VOC.•Project Manager/Business Analyst on several operational & customer care improvement projects with a goal of client empowerment, improved client care. As automation and other improvements were realized I continually shifted resources to more proactive/forward-thinking/value add activities. •Contributor to the annual budget for Client Production Operations dept.•Project Manager & Program Lead for business unit wide ILEAD leadership program.

Managed the Production Operations department, consisting of 3 teams (Production Operations, Production Customer Support, Production QA). Oversaw the ongoing production data processing, production customer issues support & resolution, and production QA. The production environment was an Oracle backend and Oracle CRM (Seibel) front-end operating under a Unix OS. • Responsible for client data reception, data quality checks, ETL and data aggregation into SAS and Oracle DBs.• Responsible for all processing to create Health Outreach Campaign datasets that were ultimately loaded into Seibel (CRM) for subsequent Health Coaches (RNs) to perform member and provider outreach. • Program & Project Manager, converting a manual production processing operation environment to a fully automated, end-to-end operations environment, for both upstream SAS processing as well as downstream Oracle processing.• Created all associated internal and external SLAs & SOPs to support the data processing operational environment.• Accountable for the implementation, mapping, setup and ongoing support of all Tidal Enterprise Job Scheduler job streams and overall application.

• Lead a 24 x 5 Operations & Production Control team responsible for: staging, executing, monitoring and producing all weekly, semi-monthly and annual output for US & Canadian Payroll, HR and Benefits from a Global PeopleSoft HRIS System. • Directed and maintained security controls for payroll check printing, direct deposit file transmissions and all subsidiary interfaces. • Produced an annual production processing calendar that is distributed to 200+ users/vendors of our PeopleSoft HRIS System.• Produced Annual Budget for Operations Dept. (Approx. $1 million Budget).• Implemented Tidal Job Scheduling application to work with PeopleSoft System.• Developed programs for MMC Risk Department’s Errors and Omissions Systems; The Public Affairs Department’s Matching Gifts System; and the Payroll Department’s Payroll System, utilizing FOCUS & Cobol programming languages.• Responsible for installation of IBM PCs and related hardware, Wang VS terminals, and mainframe terminals.• Provided support for various PC software including: Windows 95/98/NT/ME, DOS, Lotus, WordPerfect, CC Mail, LotusNotes, Procomm, Word,Rumba/Irma, Irma file transfer, FTP, and many other software packages.

May 1988– July 1992 (4 years 3 months)Responsible for programming, report writing, and support of the following systems:• E & O Management System - Risk Management/Legal Department, written in FOCUS under VM/CMS.• Match Gifts Systems - Public Affairs, written in FOCUS under VM/CMS.• Genesys Human Resources, Payroll and Benefits Systems, programmed internal Interfaces, written in COBOL and FOCUS under MVS/ESA for entire Genesys System, programmed in the following languages: COBOL, FOCUS.

March 1986– May 1988 (2 years 3 months)• Responsible for installation of IBM PC's and related hardware, Wang VS terminals, and mainframe terminals. • Provided support for various PC software including: Windows 95/98/NT/ME, DOS, Lotus, WordPerfect, CC Mail, LotusNotes, Procomm, Word,Rumba/Irma, Irma file transfer, FTP, and many; software packages.• Set-up PC-based systems with user-friendly menu systems and performed one-on-one training with users.• Programmed and supported the Xerox 4090 Laser Printing System, including FDL programming for all forms, JDL for all batch print jobs for Payroll, Human Resources, and the Tax department. • Supported a 3com LAN.

Serviced as a 3rd class Petty Officer on the USS Kalamazo as on part of the Nimitz Battle Group for 4 years. I was part of the supply department and worked on the computerized inventory system of this AOR class ship (supply ship). In charge of 25 Supply Department personnel.

Continuing Education Courses While Working At Mmc, Business Administration And Management, General

•Worked toward degree in Applied Science & Business Administration while employed at Marsh & McLennan Companies

Certificate, Programming And Operations

2 year curriculum covering: Data Operation Concepts Hardware and Software Architecture Programming languages covered:(Cobol, RPG - II.