Summary
Overview
Work History
Education
Skills
QUALIFICATIONS SUMMARY
Websites
References
Timeline
Generic

MAKSIM A MOROZOV

Glencoe,USA

Summary

Experienced Operations Leader with expertise in strategic planning, cross-functional collaboration, and process optimization. Proven success in enhancing member satisfaction, employee productivity, and regulatory compliance. Skilled in product lifecycle management, technical problem-solving, and driving enterprise projects to achieve business excellence.

Overview

16
16
years of professional experience

Work History

Product Architect

Medica Health Plans
Minnetonka, MN
06.2021 - Current
  • Directed a process enhancement initiative that resulted in a sixty percent improvement in correspondence accuracy. Realized $50,000 in annual savings through automation of various manual processes.
    Optimized workflow efficiency by implementing targeted automation strategies.
  • Supported payment enhancement project, increasing consumer retention rate by 27%.
  • Responsible for leading and supporting multiple large-scale projects from planning to execution.
  • Engaged with Senior Leadership to develop a comprehensive 5-year strategic plan focused on achieving business objectives
  • Orchestrated the development of executive-level presentations, strengthening stakeholder involvement, and cultivating strong connections throughout the organization.
  • Architected and deployed product architecture strategy to advance business goals.
  • Contributed as a subject matter expert in ecosystem migration project.

Manager, Operations Risk Management

Medica Health Plans
Minnetonka, MN
02.2020 - 06.2021
  • Implemented regulatory changes to enhance operational compliance.
  • Served as segment liaison for Medicare Operations, facilitating effective communication.
  • Led strategic projects across segments to drive organizational goals.
  • Participated in internal and external audits to ensure adherence to standards.
  • Monitored and reported on operations to identify performance trends.
  • Identified process improvement opportunities to optimize efficiency in operations.
  • Mentored and trained new employees on company policies and procedures, fostering a knowledgeable workforce.

Supervisor, Operations Risk Management

Medica Health Plans
Minnetonka, MN
02.2016 - 02.2020
  • Oversaw department addressing member appeals and grievances for Government programs, including Medicaid and Medicare.
  • Researched regulatory changes related to Medicare and Medicaid, developing communications and training materials.
  • Conducted contract reviews to ensure compliance with regulatory updates.
  • Monitored and reported on grievance and appeal metrics to identify trends.
  • Participated in CMS program audits and internal audits, managing corrective action plans.
  • Executed process improvement initiatives to enhance operational efficiency.
  • Led internal and external projects focused on regulatory adherence and quality outcomes.
  • Developed and maintained business policies, procedures, workflows, and correspondence materials.

Government Programs Contact Center Supervisor

Medica Health Plans
Minnetonka, MN
12.2013 - 02.2016
  • Directed team of 10 to 15 full-time staff to enhance operational effectiveness.
  • Analyzed metrics for informed workforce management decisions.
  • Acted as liaison between Call Center Operations and Corporate Compliance.
  • Facilitated internal monitoring of grievances and complaints to ensure resolution.
  • Developed and managed reports for internal and external stakeholders.
  • Conducted weekly staff meetings to promote team engagement and alignment.
  • Represented department in cross-functional work groups and projects.
  • Participated actively in initiatives influencing Call Center operations.

Government Programs Contact Center Lead

Medica Health Plans
Minnetonka, MN
09.2012 - 12.2013
  • Mentor and coach during one-on-ones resulting in the team exceeding department standards
  • Act as liaison to Operations and other business units
  • Mentored Call Center Staff
  • Created and updated policies and work aids
  • Developed reports to track productivity
  • Resolve escalating members issues
  • Maintain and update KN documents
  • Daily manage approval and completion of claims payments exceptions and benefit exceptions

Health Plan Specialist

Medica Health Plans
Minnetonka, MN
10.2009 - 09.2012
  • Assisted Medicaid, Medicare and Dual eligible members with benefits, claims, ect
  • Identified opportunities for process improvement and drove initiatives to optimize productivity.

Education

Bachelor of Arts - Business Administration and Management

Minnesota School of Business
Richfield, MN
01.2012

Skills

  • Strategic planning
  • Automation strategies
  • Workflow optimization
  • Risk management
  • Team leadership
  • Product lifecycle management
  • Change management
  • Project management
  • Regulatory compliance
  • Performance management
  • Technical problem solving
  • Product development strategy

QUALIFICATIONS SUMMARY

Dynamic leader and motivator with track record for training and developing high-performing compliance teams, providing organization-wide compliance training, assuring regulatory compliance, and mitigating corporate risk and liability.

References

References available upon request.

Timeline

Product Architect

Medica Health Plans
06.2021 - Current

Manager, Operations Risk Management

Medica Health Plans
02.2020 - 06.2021

Supervisor, Operations Risk Management

Medica Health Plans
02.2016 - 02.2020

Government Programs Contact Center Supervisor

Medica Health Plans
12.2013 - 02.2016

Government Programs Contact Center Lead

Medica Health Plans
09.2012 - 12.2013

Health Plan Specialist

Medica Health Plans
10.2009 - 09.2012

Bachelor of Arts - Business Administration and Management

Minnesota School of Business

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