Philadelphia, Pennsylvania, United States
Senior Operations Executive with extensive and diverse industry experience focused primarily on health care and financial services. Strong background in operations management, continuous improvement, implementation of enterprise-wide complex change programs, strategic planning, mergers and acquisitions, and account planning and sales. Leadership skills culled through extensive supervising, mentoring, and coaching responsibilities. AREAS OF EXPERTISE Leadership | Operations Management | Program Management | Mergers & Acquisitions| Change Management Continuous Improvement | Strategic Planning | Sales Management | Cross-Functional Collaboration Vendor Management | Risk Management | Business Analysis |Financial Services | Healthcare | Managed Care
Lead operations for this nationally recognized nonprofit managed care organization. Drive CareSource's mission to transform health care for millions of people across Medicaid, the Health Insurance Marketplace, and Medicare by overseeing a wide range of critical areas including operations, network, sourcing and procurement, customer care, digital strategy, implementations, member and provider communications, brand and advertising, and public relations functions.
Accountable for Aetna’s Service Operations which includes: Medicare operations, Medicaid operations, and Commercial operations (Member Services, Claim, Enrollment, Appeals and Grievances, Plan Sponsor Services), and Aetna Shared Services including payment integrity, banking functions, vendor management, compliance, business transaction support (intake, print, eCommerce), service escalation, business process improvement, and compliance. Partner with lines of business to define and drive new consumer engagement strategies and integration capabilities, ensure operational readiness, drive continuous improvement and technical program changes and provide for business continuity. Drive employee engagement and lead talent and culture changes.
Led operations of the Medicare and Medicaid business units for the nation’s fourth largest PBM. Accountable for: implementation of Medicare STARS program, leading Government Services Operations including PDE, transition, EOB, plan finder, CMS reporting, regulatory interpretations and translating to systems and process requirements and testing, vendor oversight, audit support, conducting client meetings, managing performance guarantees and service levels, and driving new business through the development of an EGWP offering and supporting RFP and finalist presentations to drive new PBM business.
Accountable for the strategic direction and operational execution of member services group which included: customer service, vendor management, enrollment, grievance, service escalation and special projects. Worked across all operations areas to define and drive new product and market expansion activities to completion, ensure operational readiness, deliver business process improvement and technical program changes and to develop and initiate training for associates and vendor partners.
Conducted business process design and information flow optimization projects focused on improving key performance indicators and service level agreements to drive cost reductions and service enhancements. Developed and utilized business and IT program and project management tools to deliver large-scale technology changes and led teams in all phases of system integration and business process management projects.