John Lopez Email & Phone Number

Zephyrhills, Fl, Us

Tampa, Florida, Us

• Monitor and evaluate the performance of the FLiP Coach on a weekly and monthly basis to ensure they are meeting the expectations and objectives of the role.• Hire, onboard and train team members and Assign cohorts/Projects to FLiP coaches and determine any sub-standard performance, weakness and Train team members/coach to maximize performance. • Evaluate alternative CRM software platforms and resources. Develop & maintain a schedule of virtual (and where possible, in person) meetings that will create a team culture, that will foster pride in the work we do and a very high level of excellence in job performance. • Will be responsible for weekly collection, approval and submission of payroll information and any bonus’s earned. Also suggest refinements and/or alternatives to the current pay plan for FC’s

Grapevine, Texas, Us

Clearwater, Florida, Us

• TPA & Healthcare Carrier. Onboarding licensed Insurance agents with front & back-end oversight.• Managing Member/Provider Inbound/Outbound Customer Call Center and oversight to training Department and technical implementation.• Provide oversight, control, and direction for enterprise-wide compliance with various Federal and State controls and regulations.• Achieve acceptable levels of assurance in terms of its governance structure, business processes, and business information. • Align strategic goals and objectives with decisions regarding products and services, partners and suppliers; organization; capabilities; and key business and IT initiatives. • Lead 3 separate departments that encompassed 4 supervisors, a Trainer & up to 120 agents including 3 admin business analysts, in business motivations, business operations and business analysis frameworks and related networks that link these aspects of the enterprise together. • Help to develop an integrated view of the enterprise using a repeatable approach, cohesive framework, and available industry standard techniques.

Florham Park, New Jersey, Us

As a Regulatory Compliance Manager my key role is to provide oversight, control, and direction for enterprise-wide compliance with various Federal and State controls and regulations. As part of the Conduent Regulatory Compliance Team, the expectation is to achieve acceptable levels of assurance in terms of its governance structure, business processes, and business information. Align strategic goals and objectives with decisions regarding products and services; partners and suppliers; organization; capabilities; and key business and IT initiatives. • Lead a Fee Schedule/Configuration Team in business motivations, business operations and business analysis frameworks and related networks that link these aspects of the enterprise together.• Develop an integrated view of the enterprise using a repeatable approach, cohesive framework, and available industry standard techniques.• Identify and analyze case reports for all 50 states that governed Workman Compensation Legislation & Regulations for Clients Bill Review process.• Auditing & Oversite on Case Issues that have been completed by Fee Schedule Business analyst and making sure Requirements and specific criteria’s have been completed.

Tampa, Florida, Us

• As a Business Operations Architect my key role is to structure the enterprise in terms of its governance structure, business processes, and business information.• Align strategic goals and objectives with decisions regarding products and services; partners and suppliers; organization; capabilities; and key business and IT initiatives.• Develop an integrated view of the enterprise using a repeatable approach, cohesive framework, and available industry standard techniques.• As a Configuration Manager my Responsibility is for accurate and timely implementation and maintenance of critical information on claims databases. • Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.

Teaneck, New Jersey, Us

• As a Claims Supervisor/Team Leader, the oversight, planning and directed activities for the business function (or multiple functions) within Claims Operations. • Process improvement and project management are key aspects of this position. Assignments are broad in nature, usually requiring considerable creativity, originality, and ingenuity.• Manage and train all team members in which are an integral part of the Claims project under BPS for Cognizant.• Proven SLA’s & production goals have consistently met all task’s that have been delegated for completion.

Tampa, Florida, Us

As an Operations Support Specialist, I serve as a subject matter expert in interpreting and completing a wide range of Operations related requirements, processes and programs and ensures all operating areas policies, procedures, and processes are in compliance.Support Operations across multiple product lines in conducting and providing audits, assessments and reports, as well as delegation actions, and ensures that all operations are functioning in accordance with all state and/or federal regulatory requirements.Key Duties and Responsibilities:• Accountable for critical/complex processes or functions within the department.• Serves as liaison between departments when it becomes necessary due to member or workflow issues.• Develops, recommends, and implements process improvements to improve efficiencies and services provided.• Updates and creates resources on Well Care link applicable to assigned area, such as timely announcements, step actions, reference call tools, FAQs etc.• Ensures associates are trained on new processes and receive refresher training.• Creates/revises training as needed.• Facilitates and participates in meetings with other departments and line of business as needed.• Act in a liaison capacity for the Mgr. / Sr. Mgr. representing Operations with other areas and business units.• Handle agent inquiries and complex claim issues• Work closely with Vendors to identify & implement procedures and processes to streamline departmental efficiencies.• Design, Plan & Execute Projects that would include the development of BRD & FSD requirements.

Us

As an Enrollment Quality Analyst I conduct the necessary research and coordination to ensure all Enrollments, Disenrollment's, Plan Changes and Reconciliation activities are accurately processed. I also conduct audits and provide feedback to reduce errors, improve processes, performance and ensure quality and consistency. Interactions are done via telephone and written correspondence with the Compliance team(s) to ensure the Enrollment Department meets and exceeds all regulatory standards. Additionally, I work closely with Compliance regarding coordination to HIPAA, Model Audit Rule (MAR), Healthcare Effectiveness Data and Information Set (HEDIS), and any other CMS or compliance related activities.

Hartford, Connecticut, Us

Provided customer service to clients, which included provider services and member services. Resolution to claims and member benefit issues.

Associate Of Arts And Sciences (Aas), Medical Office Management/Administration

Associate Of Arts - Aa, Criminology