• Direct the operational readiness team accountable for the integration of technical, people and process changes to ensure a smooth end user experience as a result of change from Strategic Initiatives and Partner Plan Business.• Consult external clients through their migration to core processing platforms addressing organizational structure, roles, security, workflow, desk level procedures and training. • Design and deliver training to internal and external clients across all lines of… Show more • Direct the operational readiness team accountable for the integration of technical, people and process changes to ensure a smooth end user experience as a result of change from Strategic Initiatives and Partner Plan Business.• Consult external clients through their migration to core processing platforms addressing organizational structure, roles, security, workflow, desk level procedures and training. • Design and deliver training to internal and external clients across all lines of business and core platforms. • Responsible for developing and analyzing the Strategic Operations SVPs entire operational budget exceeding $68M in administrative costs and a multi-million dollar project funding allowance.• Oversee departmental compliance and privacy processes and procedures, including Model Audit Rule and SSAE16. • Develop and issue all Strategic Operations internal communications.• Audit and analyze project funding. • Consult on vendor management practices and processes.• Manage the on-boarding process for all contracted staff.• Work stream lead for Strategic Operations Transformation focused on People Matter.• Work stream lead for end-to-end process knowledge. Show less

• Directed the Program Management Office accountable for the delivery and execution of technical, people and process changes through a defined three-year program saving $65M in administrative costs. • Presented Program status to senior leadership on a regular business addressing financial status, issues, risks and mitigation plans.• Participated in the organizations Culture team.• Responsible for communications and large event planning across the entire Health Plans Operations… Show more • Directed the Program Management Office accountable for the delivery and execution of technical, people and process changes through a defined three-year program saving $65M in administrative costs. • Presented Program status to senior leadership on a regular business addressing financial status, issues, risks and mitigation plans.• Participated in the organizations Culture team.• Responsible for communications and large event planning across the entire Health Plans Operations organization. Show less

• Responsible for an Operational Budget exceeding $74 million for VP of Shared Services.• Managed a team of operational business analysts accountable for root cause analysis, performance management and metrics, and process development. • Consulted affiliations in the transition of workload accountabilities, best practices and performance monitoring for claims and customer service.

• Responsible for an Operational Budget exceeding $74 million.• Developed a financial planning guide for the management team outlining the budget process, helpful facts, review of applicable system reports, and each person’s accountability. • Selected by Senior Management to be Project Manager for the transition of Highmark FEP claims and customer service workloads to Mountain State Blue Cross Blue Shield. • Completed an analysis of the cost-to-do business for front-end claim… Show more • Responsible for an Operational Budget exceeding $74 million.• Developed a financial planning guide for the management team outlining the budget process, helpful facts, review of applicable system reports, and each person’s accountability. • Selected by Senior Management to be Project Manager for the transition of Highmark FEP claims and customer service workloads to Mountain State Blue Cross Blue Shield. • Completed an analysis of the cost-to-do business for front-end claim tasks and worked with the management team to recommend more cost effective approaches to handle workloads. • Created a database to track and report the percentage of telecommuters within Health Plan Operations in relation to the 2007 Strategic Initiatives and Pandemic Initiative. • Orchestrated the creation of an Operations Performance Brochure outlining potential points, performance categories, and goals for the Member Touchpoint Measures, Inter-Plan Performance Index, and FEP Performance Incentive Program for distribution to all employees within Operations.• Assisted in the critical planning, coordination, and realignment of Health Plan Operations for Shared Services Operations.• Partnered and established a positive rapport with Mountain State Blue Cross Blue Shield management, which contributed positively to the improved business relationship among Mountain State and Highmark.• Participated in a workgroup to create a Business Process Outsourcing (BPO) and Application Service Provider (ASP) platform model. Show less

• Supervised a team of nearly 50 employees comprised of clerical staff, claim processors, customer service representatives, and technical assistants. • Developed employees to meet and exceed performance goals in both quality and quantity relative to PTS, MTM, and EIC goals. • Coached and encouraged employees to perform with excellence and to submit suggestions for improvement to enhance overall service levels and employee morale.• Profound knowledge of call center management… Show more • Supervised a team of nearly 50 employees comprised of clerical staff, claim processors, customer service representatives, and technical assistants. • Developed employees to meet and exceed performance goals in both quality and quantity relative to PTS, MTM, and EIC goals. • Coached and encouraged employees to perform with excellence and to submit suggestions for improvement to enhance overall service levels and employee morale.• Profound knowledge of call center management, customer service functions, claim entry, universal claim processing, and project management. • Lead projects to enhance service levels, maintain customer satisfaction, and improve inter-departmental relationships.• Developed guidelines and procedures to comply with regulations, improve efficiencies, and reduce costs.• Maintained a strong ability to identify, analyze, and solve problems leading the team to success.• Project Lead for the Facility NaviNet Initiative workgroup.• Implemented facility servicing in the Central Region, which was the first time Pennsylvania Blue Shield performed facility claims processing and servicing for our members and providers.• Built strong relationships with all customer bases to achieve goals.• Facilitated a Quality Improvement Team for Provider Service to improve accuracy, streamline processes, achieve consistency, and flowchart processes. Show less

• Assumed specific accountability for leading work measurement process improvement and performance management efforts. • Developed and implemented management strategies, programs, and policies to support the continuous improvement of quality, service delivery, and cost efficiencies within the Customer Service units.• Conducted interviews with management and front-line staff to assess performance obstacles and proactively identify system capability needs and training requirements.•… Show more • Assumed specific accountability for leading work measurement process improvement and performance management efforts. • Developed and implemented management strategies, programs, and policies to support the continuous improvement of quality, service delivery, and cost efficiencies within the Customer Service units.• Conducted interviews with management and front-line staff to assess performance obstacles and proactively identify system capability needs and training requirements.• Closely monitored quality control statistics and cost efficiencies; initiated work measurement studies and corrective actions to address any problematic trends.• Lead and participated in cross-functional teams through all phases of process re-engineering efforts including flow-charting, work measurement, testing, and implementation.• Developed orientation and training presentations for staff of all levels to facilitate the transition to procedural or system modifications.• Implemented control mechanisms to ensure full compliance with all government, industry, and corporate requirements. Show less