Kim M. Long
Hillsborough,NC
Summary
Strategic operations leader with a proven track record of recovering over $100 million in APTC payments and achieving 99% billing accuracy across a billion-dollar portfolio. Successfully outsourced operations, resulting in a 35% reduction in administrative costs and a decrease in manual processing time by 3.5 business days. Led initiatives to enhance operational efficiency through cross-departmental collaboration and established data governance structures that promote process automation and compliance.
Overview
28
28
years of professional experience
Work History
Senior Manager
Blue Cross NC
Durham, NC
01.2023 - 04.2026
- Managed operational delivery department, ensuring core processing system efficiently handled enrollment billing and fulfillment transactions.
- Led cross-functional teams to enhance operational efficiency in healthcare services.
- Developed and implemented strategies to improve operational efficiency, reduce costs, and increase productivity.
- Implemented process improvements to increase operational efficiency and reduce costs.
- Oversaw compliance with regulatory standards in health plan operations.
- Developed strategic initiatives to improve patient engagement and satisfaction.
- Developed strategic vision for framework in collaboration with product strategy, sales, marketing, and account implementation.
- Provided oversight to interconnected teams for effective execution of end-to-end delivery value chain.
- Established data governance structure and automation tools, monitoring team compliance effectively.
- Collaborated with IT to implement new workflow management systems.
- Collaborated with stakeholders to accurately derive technical requirements from business needs and support workflow sequencing.
- Prepared and reviewed departmental budget forecasts to ensure accurate financial modeling.
- Adapted system enhancements and fine-tuned processes to maximize throughput and operational efficiency.
Senior Manager
Blue Cross NC
Durham, NC
12.2019 - 01.2024
- Implemented an Enrollment Reconciliation team to oversee our PPR data analysis process, resulting in over $100Mil in APTC (Advanced Premium Tax Credit) Payments reconciled over a 4-year period; Monthly average of $252Mil in APTC payments from CMS (Centers for Medicare and Medicaid Services).
- Over a 4-year period, drove billing accuracy to 99%; over 1Billion Total Billed Per Plan-Year.
- Led Annual Enrollment Business Readiness for Commercial and Senior Market Fulfillment, Individual Enrollment; Individual, Group and Senior Market Billing.
- Developed and implemented business program strategies for Account Implementation, Enrollment, Billing and Fulfillment.
- Managed vendor relationships with commercial fulfillment vendors, created contract summaries, monitored service level metrics, and validated budgeted invoices for approvals.
- Coordinated, developed, and implemented automation for Individual Enrollment and Centralized Billing.
- Facilitated performance benchmarking, developed control reports, and implemented process improvements through financial reporting risk management.
- Prepared monthly staffing model metrics to monitor capacity and budget across cost centers.
Manager
Blue Cross NC
Durham, NC
10.2017 - 12.2019
- Fostered connection to member experience and front-line challenges, driving member-centric culture of accuracy and timeliness that proactively identified issues and addressed root causes.
- Collaborated with business leads from Core Production and Core Services to enable end-to-end operations value chain aided by timely and accurate billing.
- Established communication channels with Core Services leads to ensure timely and accurate billing for members; managed relationship with Finance team to uphold billing integrity.
- Managed cash receipts within finance and billing operations to meet all performance expectations.
- Designed, implemented, and managed scalable functional processes that are flexible to resource deployment needs.
- Identified and pursued process standardization and automation opportunities to enhance effectiveness and reduce errors.
- Collaborated with Managers from Configuration, Core Production, Core Service, and IT Solution Delivery to identify areas that drive member escalations.
- Partnered with Continuous Improvement and Vendor Services teams to identify improvement and sourcing opportunities, including process optimization through Lean-Six Sigma methodologies.
Senior Team Leader
Blue Cross NC
Durham, NC
10.2014 - 10.2017
- Acted as liaison for Individual Refresh (IRRE), facilitating communication and support.
- Resolved escalated issues for Regional Sales Executives, Customer Service, and Business Partners.
- Contributed to Business Process Improvements and developed queries to identify gaps between Finance, Billing & Reconciliation, and Membership.
- Assisted Financial Processing Services and Billing & Reconciliation with reinstatements, refunds, and queue management.
- Understood finance and billing rules for individual exchange transactions.
- Actively participated in Business Requirements for Renewal and Migration Projects.
- Created Test Cases for Validation and Regression Testing.
Team Lead
Blue Cross NC
Durham, NC
06.2013 - 10.2014
- Directed the Individual Member Maintenance Department as Team Lead.
- Facilitated small group enrollment, rating, and work distribution while acting as backup team lead.
- Facilitated education and training for Sales, Membership and Customer Service Professionals.
- Conducted monthly reviews, coached, and delivered constructive feedback to membership professionals to enhance team performance.
- Communicated specific requirements in preparation for Facets Migration.
- Maintained expertise in concepts and procedures related to individual and small group business.
- Coordinated Validation Test weekend criteria based on p-tickets and or new system enhancements.
- Researched and processed inquiries for departments, team leads, management, customer service professionals, and regional sales executives to resolve issues and maintain high service standards.
- Completed daily reporting of inventory metrics.
Operations Specialist
Blue Cross NC
Durham, NC
07.2007 - 06.2013
- Served as the primary contact for Regional Sales Executives, External Producers, Rating Specialists, and Underwriter inquiries.
- Educated and trained Rating Specialists, Regional Sales Executives, and Internal and External Producers to enhance operational knowledge and effectiveness.
- Conducted peer audits and coached Rating Specialists, delivering constructive feedback to improve performance and compliance.
- Served as technical liaison, assisting with system issues and optimizing work processes and procedures for better operational flow.
- Provided sound guidance to assist customers with critical decision-making regarding group eligibility.
- Validation Tested for system functionality after system enhancements in p-stage and production.
Rating Specialist
Blue Cross NC
Durham, NC
06.2001 - 07.2007
- Reviewed applications for final rates (small and medium groups) to assess eligibility and ensure compliance with underwriting standards.
- Applied underwriting guidelines and automated medical underwriting system (Blue Quote) to accurately evaluate group risk pools.
- Declined or accepted groups in compliance with DOI (Department of Insurance) and company policies.
- Coordinated with external producers to gather necessary information for timely application processing.
Underwriting Processor
Blue Cross NC
Durham, NC
01.1998 - 06.2001
- Analyzed applications by examining medical records and claims history to assess risk and eligibility.
- Reviewed consumer applications for tier-rated and rider healthcare products to ensure compliance and accuracy.
- Trained new medical underwriting processors.
- Assisted in developing scripts for telephone interviewers to enhance communication and efficiency.
Education
Bachelor of Business Administration - Minor: Leadership
North Carolina Wesleyan College
Durham, NCSkills
- Leadership and vendor management
- Certified Scrum Master
- Project management and operations
- Operational efficiency and risk management
- Regulatory compliance and strategic planning
- Organizational improvement and development
- Budget oversight and administration
- Resource allocation and operations management
- Cross-functional team leadership and coordination
- Preventive maintenance and troubleshooting
- Performance benchmarking and reporting oversight
- Data-driven decision making and multitasking
Timeline
Senior Manager
Blue Cross NC
01.2023 - 04.2026
Senior Manager
Blue Cross NC
12.2019 - 01.2024
Manager
Blue Cross NC
10.2017 - 12.2019
Senior Team Leader
Blue Cross NC
10.2014 - 10.2017
Team Lead
Blue Cross NC
06.2013 - 10.2014
Operations Specialist
Blue Cross NC
07.2007 - 06.2013
Rating Specialist
Blue Cross NC
06.2001 - 07.2007
Underwriting Processor
Blue Cross NC
01.1998 - 06.2001
Bachelor of Business Administration - Minor: Leadership
North Carolina Wesleyan College