Summary
Overview
Work History
Education
Skills
Websites
Timeline
Generic

Jaime Najera

Irving

Summary

Accomplished technology and operations executive with extensive experience in the healthcare/payor administration industry. Highly effective at leading cross-functional teams to deliver quality results for customers and highly visible corporate projects. Proven track record of driving operational excellence and implementing innovative solutions to optimize business processes and drive growth. Strong strategic thinker with a focus on driving organizational success through collaboration and continuous improvement initiatives.

Overview

27
27
years of professional experience

Work History

VP, Operations Head

Wipro
09.2019 - Current
  • Guide Operational and Technical teams throughout various business functions such as Eligibility and Enrollment, Claims Administration, Customer Service, Provider Data Management, Benefit Administration, Reporting, and Fulfillment. This includes Project Managers, Business Analysts, and Delivery Leads—to guarantee efficient planning, integration, and the accomplishment of both customer and company SLAs and KPIs.
  • Oversee the distribution of a workforce of 200 and manage financial resources while monitoring the profit and loss for a $30 million business unit, conducting evaluations on a monthly, quarterly, and annual basis.
  • Suggest and put into action methods to enhance business performance. Initiating changes and creating strategies and plans for mitigation.
  • Analyze procedures and processes, and implement enhancements across various programs, services, and initiatives that are distinguished by their scale, intricacy, and risk.
  • Assess operational capabilities by reviewing performance indicators, the effectiveness of processes, and potential areas for cost savings and/or increased efficiency, and then develop forecasts and ROI calculations for improvements.

VP Information Technology

HealthPlan Services
01.2012 - 08.2019
  • Provide technical and operational leadership, strategy, implementation, delivery, and support of the claims administration applications for the $25M Health Claims BPO business unit of HealthPlan Services.
  • Major Responsibilities:
  • Lead functional areas of IT to build, enhance, transform, and support technology and business services by successfully delivering on outcomes. Applications include Benefit and Claims Administration, Analytics and Trend Reporting, Member, Customer and Operational Portals.
  • Collaborate with leadership across various disciplines; provide guidance, direction and recommendations to address a wide range of business and technology needs with emphasis on optimized, timely and successful delivery.
  • Create and manage budgets in collaboration with the Business Unit SVP and department finance head.
  • Maintain key performance indicators and critical success factors that will monitor and improve the performance of the organization. Focus on data and analytics that drive actionable intelligence.

Consultant, Solution Architect

Applied Performance Technologies
04.2007 - 01.2012
  • As a consultant to the Harrington Health BPO Services business unit of UMR, provided solutions management and technology integration services, from strategic design to application delivery, in support of a national Self-Funding administration contract with Kaiser Permanente.
  • Major Responsibilities:
  • Provided senior technical leadership and consulting across the organization supporting the implementation of a $10 million (annual) Claims Administration contract. This was Kaiser’s first execution of Self-Funding administration services.
  • Systems integration between client and vendor for Membership, Provider Demographics and Contracting, Patient Authorization, Patient Accumulations and Claims applications utilizing IBM WebSphere MQ, VB.net, C#.net, MS SQL.
  • Worked directly, through on-site JAD sessions, with Kaiser Permanente national business partners (Membership, Provider Contracting, Revenue Cycle, etc) to refine solution design to meet business requirements.
  • Ensured technical teams, coupled with the Program Office, followed the Comprehensive Delivery Process standards.
  • Presented solutions and plans to wide audience, from executives (solution buy-in) to SME’s (application delivery).

VP of Technology

Fiserv Health
04.2004 - 12.2006
  • Led the technology division of the Harrington Benefits Services business unit of Fiserv Health.
  • Major Responsibilities and Accomplishments:
  • On a budget of $15M and with a staff of 100, provided Health TPA systems support to eight operations locations for 75 self-insured employer groups and one major Health Plan.
  • Worked directly with large clients and operational business unit leaders for project prioritization, schedule and delivery. Communicated with clients regarding IT performance of established service levels.
  • Negotiated contracts and service level agreements with technology and business services vendors. Re-negotiated claims clearinghouse contract for savings of $6M resulting in 33% savings over 5 years.
  • Performed all facets of personnel management. Held accountable for performance to financial budget.
  • Project Delivery: Large client implementations; Major vendor software implementation; Trizetto-based FACETS and CLAIMFACTS claim system software upgrades; EDI subsystem overhaul; New Customer Reporting platform utilizing Business Objects; Major web platform enhancements; Process improvement initiatives.

Director, Transitions and Technical Sales Support

Healthaxis
01.1999 - 04.2004
  • Managed several implementations for new large clients utilizing Healthaxis services and products.
  • Major Accomplishments:
  • Transitioned 80K life group from Y2K problematic claims payment system to Healthaxis proprietary claim system. Transition followed life-cycle methodology from Analysis through Implementation. The project took 14 months and enlisted from 10 to 30 programmers for duration.
  • Managed the implementation of 5 clients to the Healthaxis Imaging and Data Capture solution utilizing Captiva’s Formware product. Transition of services included Mailroom, Scanning, OCR / Data Entry of claims, and EDI output.
  • Managed the implementation of a large Akron, OH based health plan to the Healthaxis Generic Web Self-Service Modules. These modules enabled Employers, members, and customer service access to eligibility and claims information.
  • Provided Project Management support for the implementation of Healthaxis’ Web-enabled Healthcare Eligibility and Membership Administration system. Implementations were for the State of Washington and the State of Georgia.
  • Provided technical sales support. Managed clients from contract through implementation.

Education

BA - Managerial Studies

Rice University

Skills

  • Leadership
  • Staff Management
  • Project Management
  • Technical Sales Support
  • Process Analysis/Improvement
  • Business Integration
  • Strategic Planning
  • Software Package Selection
  • System Integration
  • Data Analytics
  • Data Visualization
  • Client Engagement
  • Client Management

Timeline

VP, Operations Head

Wipro
09.2019 - Current

VP Information Technology

HealthPlan Services
01.2012 - 08.2019

Consultant, Solution Architect

Applied Performance Technologies
04.2007 - 01.2012

VP of Technology

Fiserv Health
04.2004 - 12.2006

Director, Transitions and Technical Sales Support

Healthaxis
01.1999 - 04.2004

BA - Managerial Studies

Rice University

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