PROFESSIONAL PROFILE

Well experienced management professional offering accomplished qualifications in progressively challenging positions within turn around and startup organizations. Background encompasses global leadership of call center and operations management. Solid quantitative, analytical and technical aptitude, balanced by highly developed interpersonal and presentation skills. Change agent and strategic thinker who has significantly improved department performance at every juncture. Proven ability to design, develop and implement policies necessary to support the Operations and Call Center improvement process. Demonstrated history of working within parameters of government contracts. Ongoing awareness of legislation relevant to position. Enthusiastic learner who rapidly assimilates and incorporates new information. Reputation for diligence, follow-through and dedication to quality outcomes and results.

EXPERIENCE

Confidential

Director, Provider Services

• Oversee daily operations of the following business functions: Provider Outreach and Education, Provider Enrollment, Customer Assistance and EDI Help Desk.
• Successfully implemented process changes specific to Healthcare Reform and the Affordable Care Act.
• Implemented ongoing and refresher training in the customer assistance area reducing average handle time and increasing provider and member satisfaction.
• Established weekly client meetings to improve client satisfaction and communication.
• Business sponsor and single point of contact for new call center technology initiatives that included moving from standalone premise telecommunication switch to VoIP with improved IVR / self-service utilization.
• Key participant in the CORE MMIS Request for Proposal RFP response team.

Confidential

Claims Manager II

• Assumed full responsibility for reducing aged inventory, changing inventory management philosophies through coaching and mentoring peer managers and staff to achieve CMS claims processing contractual requirements. Successfully reduced aged inventory within seven months.
• Successfully reduced aged claims inventory by 58 within five months, while reducing staff by 30 and overall claims unit cost.
• Streamlined all daily reporting and instituted daily inventory management calls.
• Conducted SWOT analysis to assess overall gaps in claims operations and established project plan to ensure change is effectuated at all sites.

Manager of Operations

Confidential

• Oversaw daily operations of the shared services business, including imaging of 4.5 million documents annually, opening and distributing 1.4 million envelopes and packages annually to five locations, coordinated clean up activities within the department and developed initiatives that accelerated same day service from 7 days to 1 day.
• Developed and implemented quality assurance program achieving a 99.48 quality score against a 95 target established individual and team goals coached and mentored to achieve department requirements.
• Increased internal customer satisfaction by improving same day service.
• Reduced 09 budget by 33 compared to 08 budget.
• Reduced 09 headcount by 36 compared to 08 headcount.
• Reduced mail hub operations from two hubs to one hub within six months while maintaining same day service level and reducing overall costs by one million dollars.

Director II

• Reduced nine-month critical case backlog by implementing workflows and inventory reporting structures. Backlog was current and compliant within 60 days. WellPoint was released from all CMS sanctions relevant to this workload.
• Expanded responsibilities to oversee service center for Medicare Part D, Medicare Advantage-Private Fee For Service MA- PFFS , Individual, Group and Medicare Advantage Part D MAPD member and provider inquiries for legacy Central and Unicare. Included workforce management, training, quality assurance and process improvement.
• Confidential for commercial senior business unit contracted with Centers for Medicare and Medicaid Services CMS to respond to Medicare Part D, Medicare Advantage and Medicare Supplement member and provider inquiries across the United States and CMS Complaint Tracking Module CTM critical case management enterprise wide.
• Restored confidence of Northeast business partners by improving customer service delivery to their membership base. This allowed WellPoint to win back their service center operation and eliminate the third party vendor.
• Restored confidence of agent sales force by conducting agent outreach program and providing improvement plans for both customer service and claims.

Director I

Confidential

• Oversaw 3 separate contracts, covering Medicare questions from providers, suppliers and beneficiaries across 15-state area managed service center operations, electronic data interchange EDI technical help desk, quality assurance, customer service, employee training, workforce management, data analysis and process improvement.
• Established standalone claims gateway for EDI to improve auto adjudication rate.
• Responsible for call flows and Interactive Voice Response IVR design. New design increased utilization from 40 to 81 that resulted in a reduced cost per call.
• Business Sponsor and single point of contact for all service center technology initiatives that included workforce management, call recording and common desktop applications, which are currently being utilized enterprise wide.
• Business Sponsor and team leader for enterprise ISO9001:2000 certification initiative. Certified on October 18, 2005.
• Led enterprise call center integration core team, which determined consolidation strategy of eight service centers to three service centers due to the WellPoint WellChoice merger.
• Ensured compliance with government laws, regulations and directives that are subject to review by CMS, Office of Inspector General and outside auditors.
• Implemented changes that led to five consecutive years of exceeding CMS requirements and operating within Medicare budget.
• In each of five CMS audits, call center was found to be without any major or minor deficiencies in 2001 - 2005 achieved scores of 99 and 100 compliance with nearly 300 separate standards.
• Lowered staff turnover by 20 in first year.
• Call Center SME for RFP writing team and final review teams.
• Selected for and completed Strategic Leadership Program offered by Indiana University Kelley School of Business Executive Partners.

Call Center Manager Confidential

• At hire, inherited call center handling inquiries over 9-state area which was not passing contractual, performance and budgetary standards effected immediate changes including:
• Hired many new customer service representatives for 50-member staff, enhancing center's performance immediately.
• Communicated expectations and established exacting performance standards/expectations.
• Secured additional funding from Center for Medicare/Medicaid Services.
• Initiated technical changes to telephone switch, leading to swifter response and greater efficiency.
• Successfully underwent annual CMS audit while in 1999, contract was in jeopardy and performance was deemed substandard, 2000's audit found that standards were met and determined that contract was no longer at risk.
• Some of new procedural/performance standards were noted and included within CMS Call Center Best Practices.

Confidential

Technical Instructor

• Trained customers, business partners and employees on diagnostic development course, outlined practical steps needed to design and implement diagnostics within call center.
• Developed courseware for Support Center training and Train-the-Trainer courses for various Corepoint products delivered on-site training as needed.
• Participated as member of product delivery teams, keeping abreast of feature/function diagnostic software enhancements.
• Led implementation teams with Support Center client installations ensured that training materials met customer requirements.

Confidential

Manager of Customer Operations for 60-seat customer service contact center that resolved written and telephone questions from wireless telephone users.

• Held full responsibility for 4 million budget managed and developed 5 customer service managers.
• Spearheaded improvement of department performance standards, which led to 50 reduction of employee turnover and significant, measurable improvement in overall performance.
• Selected for Leadership Indiana Executive Development Program.

• Utilized monthly incentives and published individual agent performance, which helped reduce abandon rate by 50 and increased average agent availability from 78 to 95 .
• Opened and closed special lines for peak periods and adjusted coverage to maximize agent availability these changes allowed center to receive an additional 3,500 calls daily.
• Collaborated with other department managers to evaluate staffing needs participated in recruitment, selection, training and evaluation of employee for Customer Operations Department.
• Devised process for managing executive complaints and customer escalation from Better Business Bureau, Attorney General and FCC result was decrease in turnaround time from 10 days to 48 hours.
• Implemented inbound call monitoring and immediate feedback program, substantially enhancing customer satisfaction.
• Reduced talk time 50 by training department on interpretation of new digital bill format.
• Business Sponsor for customer database conversion team.