SUMMARY:

• Managed and governed mission critical Releases, Major Platform Migrations, Complex Regulatory Implementations (Business/Technical, impacting all Corporate Departments), Software and Product Developments, Process Initiatives
• Program Manager, Account Executive (to include Portfolio Management, customer facing, onsite, remote, matrix, 24X7 support, multiple methodologies)
• Selection and implementation of enabling technology and business practices to achieve strategic goals and operational improvements
• Relationship link between business and technical to formulate and execute tactical activities
• Proven leadership with strong partnership and team building across organizational structure
• Budgetary Management (Budget, Profit & Loss, Product / Service ROI)
• Senior Systems Engineer (software development, configuration, infrastructure, architecture, operations, process / procedure development, embedded technologies, data analytics, simulation/predictability, and service management)
• Project Management Methodologies: Agile, Six Sigma, Scrum, DMAIC, Kaizen, XP (Extreme Programming), Crystal, FDD (Feature Driven Development), DSDM (Dynamic Systems Development), Adaptive Software Development, RUP (Rational Unified Process), Critical Path Method (CPM), Event Chain Methodology (ECM), Critical Chain Project Management (CCPM), and Traditional
• Health care Membership / Billing, Benefits, Claims Processing, Adjudication, Accumulations, COB, Financial and Reporting across multiple heath care payer products; Individual/Family, Medicare, Medicaid/State, Private /Public Group Plans
• Managed Major Health Insurance Platform Migrations and Complex ACA/Reform Projects

PROFESSIONAL EXPERIENCE:

Confidential

Technical Lead

Responsibilities:

• Developed and implemented Information Technology Governance, Supplier/Vendor Management and Enterprise Release Management strategy using Information Technology Service Management (ITSM) Library framework and ServiceNow. Reduced project life cycle time and cost through integration of system and process components across corporate portfolio to ensure development synergy and risk/issue transparency
• Schedule and monitor all enterprise deployments of major upgrades, software patches, business enhancements, patches
• Coordinate business needs, training, internal and external information technology staffs with corporate strategy and initiatives, resource allocation, budget and timeline
• Report metrics to Corporate Governance (current and predictive models)
• Initiate and lead process improvements and ensure compliance, for example;
• Process to gather business requirements for major system enhancements took approximately 3 - months with most resulting requirements not supportive of corporate goals and requirements inconsistent with cross departmental needs.
• Created single enhancement requirements document accessible, via SharePoint, by all business units. Added two simple data points per enhancement;

Confidential

Senior Consultant, IT Delivery Manager, Release Manager, Program Manager

Responsibilities:

• Managed project portfolio for the operating system migration required the balance of multiple business interests and competing priorities. Implementation with current, emerging and innovative technologies ($150+ million, 400,000 work effort hours, 600+ requirements, and 232 full time human resource equivalents)
• Managed migration assessment to document program for the migration of national members (10+ million) from legacy mainframe system to new platform / system, and identify product and processing gaps, business and technical solutions
• Managed system requirements and design for 71 critical integration points with the new operating architecture, utilizing SSH (secure web-based shell) file transfer protocol
• Collaborated to invent a means to automate manual process and bring increased productivity and greater efficiency to the cash receipt process. Return on Investment included; eliminate the high volume of manually keyed receipts, eliminate receipt errors, reduce time to reconcile General Ledger. Intangible benefit included (measured over long-term) obtaining corporate goal of being customer centric, responsive, service organization
• Managing the development was done by utilized an Agile approach and delivering CARDS into Production within 15 months. A total of 618 requirement refinements, defect corrections, and enhancements assessed, scoped, built, tested and deployed
• Managed system planning and development for the accumulation of customer (member) medical and pharmacy benefit management (PBM) out-of-pocket expenses. Coordinated file / integration design, testing and implementation between the claim host processing system and multiple vendor applications
• Manage the development of marketing plan to include business growth plan, operational effectiveness, efficiency, and RFP process for global resources. Focus on process optimization and improved delivery. Efforts focused on measurement of superior project delivery, Business and Information Technology services while continuing a close partnership with Plan client to bring about efficiency, effectiveness, and affordability
• Managed the development of knowledge retention, and transfer, program and implemented SharePoint configuration for management of corporate project / product intellectual assets
• Develop and implement innovative technical and business solutions in support of mission critical goals and objectives. Lead due diligence studies, contract proposals, SOWs / SLAs, system acquisition, systems integration engineering, production and logistic support
• Establishment and implementation policies and procedures to support vital systems / projects to include; financial (P&L) / budget, strategy alignment, risk management / crisis situations, System Development Life Cycle, quality (measure of satisfaction, requirements matrix), and communications
• Researched and authored The Health Care Payer Industry - 2014 And Beyond, strategic initiatives to improve consumer, provider experience and interaction, reduce corporate and program costs
• Developed and implemented Confidential ™ (program methodology that reduced project cost by 30%, production defects by 24% and time to market by 12%), A2A™ Assessment-2-Action that reduces project assessments from months to weeks and delivers fact-based data for prioritization, ROI and integration
• Successful application of computer science and computer engineering to research, design, develop, test and evaluate software and firmware for applications, databases, network security and privacy. Establish security policies and procedures, conduct executive review and approval, corporate training, infrastructure design and implementation management
• Managed business/product development and integration of all Confidential, Confidential and 3rd party practices. Developed Release Management for system and business process release of integrated solution involving Confidential, BCBSMI, IBM, EDS and other 3rd party suppliers. Developed User Acceptance Test Strategy. Created Release Management, User Acceptance Test, Requirements Traceability Matrix strategy and contract proposal for integrated solution that involved corporate stakeholders, primary IT vendors and other third-party suppliers
• Manage assessment, best practice identification, process development, organizational readiness, implementation and operational support for Horizon BlueCross BlueShield of New Jersey Operational Excellence, Horizon IT Effectiveness. Develop, execute and control First Pass Rate Reduction Program (Operational Excellence) utilizing Six Sigma, DMAIC, and Kaizen. Directed IT product development, quality assurance, RFPs, vendor management, and SLAs. Developed and directed business and technical process improvements in direct support of business revenue and commercial sales/marketing goals. Systems development, IT and business process improvement. Developed and delivered a corporate quality assurance solution to ensure system developments and business processes are initiated, controlled, and managed so that corporate goals are met or exceeded, provide employee growth, and achieve superior customer service
• Developed and directed business development processes at Confidential including issues resolution, cost modeling, staffing, program methodology, and key success factors. Implemented formalized Release Management, User Acceptance Test, Quality Assurance policies, procedures, processes and tools
• Created Request for Proposal Process, and managed RFP process, for new IT systems (Benefit Configurator) development, from pre-solicitation planning to post-award phase. Created 4-year, $50 million proposal to consolidate and integrate customer’s local business (1.2 million subscribers) to a single system, obtained executive and board approval
• Developed and delivered a corporate solution to transform Confidential business and system applications to comply with multiple State Anti-Theft legislation and Confidential Association requirements. Project completed on-time and under the $30 million budget. Created and maintained project work plans that covered 400,000 work effort hours, 232 team members and 9000 deliverables. Re-engineered business processes effecting 44.7 million annual customer inquiries and providing $6.2 billion in annual benefits. Renovated existing system applications that process 116.4 million claims annually. Creation and issuance of new identification cards for 4.7 million members
• Developed enterprise wide detailed business and technical requirements gathering process and database application for Confidential Requirements Database. Tool allows collaboration and workgroup development of business and technical requirements. Provides analyst with the ability to quickly assess organization and business impacts, maintain requirements consistency and integrity while also providing the ability to manage scope, timeline and cost.
• Rapid completion of multiple databases to maintain, retrieve and mine data, including a Regulatory Interpretation Database (rapid and consistent application of legal department interpretation of State and Federal regulations in developing business processes, policies and making system enhancement decisions)
• Developed / implemented corporate solution to transform Confidential business and system applications to comply with the Health Insurance Portability and Accountability Act (HIPAA). Scope included all internal lines of business, employees, business partners and customer membership. Created and implemented program methodology and project charters, provided strategic guidance to executive leadership on privacy and security regulatory matters, developed and delivered privacy and security awareness and educational communications, identified contractual obligations and conducted follow-up to ensure vendor agreement compliance
• Successfully directed the IT vendor and data center transition, included successful resolution of technical and business issues as they related to the transfer of services, technologies and knowledge transfer from EDS to IBM. Managed the delivery of Service Level Agreement (SLA) & New Product Projects (NPP). Developed and managed work plans covering $5 million budget, 400,000 work effort hours and 1000 deliverables

Confidential

System Engineer Supervisor, System Engineer Manager, Account Executive

Responsibilities:

• Inbound Transportation (Manufacturing Logistics), Management of services and products to support Confidential in-bound transportation of goods and products for global manufacturing facilities. Increased productivity and morale of Inbound Transportation & Logistic Systems Team from a 0.5 to a 4.6 rating, on a 0-5 scale, 0=lowest, 5=highest, within 1 year.
• Managed development of Confidential plant floor system (vehicle diagnostic link) and dealership repair system (vehicle service).
• Responsible for full system development life cycle and accountable for project/program time, cost, quality, resources, risk management. Recipient of the Confidential Excellence Award for the development and delivery of an integrated manufacturing and dealer system that tracks birth of vehicle through dealer maintenance.
• Proposal, and lead engineer for implementation, to Daewoo Motor Company, expanding global business for manufacturing diagnostic system that validated vehicle engine, transmission and body control modules for all global production. Expanded business from Initial site implementation ($2 million) to all domestic sites ($40 million). Created export documents in compliance with technology export laws and created and managed vendor agreements.
• Assemble Line Diagnostic Link ( Confidential ), Static and Dynamic Simulation (Multiple projects based on Product Line and new Model Year
• Responsible for the real-time application development and system architecture of the Confidential . System responsible to test on-board computer and sensor technology (engine, powertrain, braking, body controls) installed on all Confidential vehicles globally.
• Managed the development, integration and deployment for all Confidential final assembly plants.
• 24X7 support requiring rapid root cause analysis and fix to eliminate/mitigate lost revenue due to shipment delays.
• Increased revenues from $2.5 million to $7.0 million, and increased scope from Confidential North American plants to Confidential assembly plants globally.
• Served as technical subject matter expert, managed and mentored staff, proposal development, negotiations, client delivery, compliance monitoring, cost control, schedule performance, quality assurance, risk management, and issue/ dispute resolution.