Francis Hebert
Windham,NH
Summary
Proven senior leader with vast leadership experience in health plan operations across various claims platforms and products.
Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture.
Analytical problem-solver with talents for team building, leading and motivating, as well as excellent customer relations aptitude and relationship-building skills. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance.
Overview
13
13
years of professional experience
Work History
Director of Claims Administration
Vaya Health
01.2023 - 07.2023
- Provide leadership and oversight for claims staff of 41 associates covering several functions of claims payment and service during a major claim system migration
- Led process, issue management and SWAT teams to quickly identify root causes of system/process failures and determine resources and solutions needed
- Lead process to fill short-staffed claims teams handling claims processing, provider claims resolution, provider training and encounter processing and reporting.
- Facilitated cross-functional collaboration for improved decision-making processes within the organization.
Senior Claims Director
COMMUNITY BEHAVIORAL HEALTH
10.2020 - 10.2022
- Provide leadership direction for staff of 25 associates covering several claims administration areas
- Rebuilt Quality Assurance function across the department
- Led process improvement training initiative for managers and staff
- Worked to improve employee engagement during virtual/remote environment
- Procured LinkedIn Learning licenses for the department to support learning and development
- Main point of contact for claims system vendor for system modifications and product updates
- Monitored team performance, enforcing compliance with corporate claims processes and procedures.
Regional Operations Director
BEACON HEALTH OPTIONS
02.2019 - 10.2020
- Responsible for ensuring consistent, high quality operational support to health plan clients
- Worked with internal shared services departments to answer questions/resolve issues with claims/denials, eligibility, provider files, encounters, complaints, credentialing and provider rates
- Reviewed/approved and sent out all weekly/monthly and quarterly reports to plans
- Held weekly operational meetings with health plans and internal operations areas (as needed)
- Assisted with health plan internal and external audits and special reporting projects
- Monitored weekly and monthly claim denial activity for new products/services.
Vice President of Claims
ENVOLVE VISION, INC
03.2016 - 06.2018
- Directed the claims department and ensured claims metrics and service level agreements were met or exceeded in over 25 states
- Ensured compliance with all state and federal claims payment laws and guidelines
- Developed, maintained, and ensured production and quality standards were met
- Added Claims Curriculum Designer aiding in the move of all workflows to SharePoint from local drives, improve content management and formalizing training programs
- Developed and implemented Root Cause Analysis training to find and correct root causes for historical audit failures
- Collaborated with senior management to develop strategic initiatives and long term goals.
Director of Claims Services
NEIGHBORHOOD HEALTH PLAN
03.2010 - 07.2015
- Implemented inventory management and staffing rigor to control inventory, improve aging and timeliness to exceed state requirements
- Worked with IT and TriZetto (vendor) to implement system enhancement on QNXT platform to improve duplicate claims and authorization logic, enhancing auto-adjudication rates to exceed 90%
- Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
- Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
- Established a culture of continuous improvement by fostering open communication channels and empowering employees to voice their ideas.
- Cultivated a positive work environment that fostered employee engagement, increased retention rates, and boosted overall team morale.
Education
Skills
- Strategic Planning
- Verbal and written communication
- People Management
- Operations Management
- Business Planning
- Staff Development
Timeline
Director of Claims Administration
Vaya Health
01.2023 - 07.2023
Senior Claims Director
COMMUNITY BEHAVIORAL HEALTH
10.2020 - 10.2022
Regional Operations Director
BEACON HEALTH OPTIONS
02.2019 - 10.2020
Vice President of Claims
ENVOLVE VISION, INC
03.2016 - 06.2018
Director of Claims Services
NEIGHBORHOOD HEALTH PLAN
03.2010 - 07.2015
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