Summary
Overview
Work History
Education
Skills
Accomplishments
Affiliations
Timeline
Community Service
Leadership Approach and Philosophy
Areas of Specialization
Professional Highlights
Executive Summary
Core Competencies
Generic

Monique Hardy

Bushkill,PA

Summary

My professional journey has been distinguished by an unwavering dedication to advancing healthcare access and operational excellence. Throughout my career, I have consistently championed collaborative solutions and strategic initiatives that place individuals and communities at the center of delivery. My leadership philosophy is rooted in the belief that effective engagement and authentic partnerships create the foundation for sustainable impact within complex healthcare environments.

Overview

10
10
years of professional experience

Work History

Director of Operations

Metro Health Plus
01.2022 - Current
  • Led health claims operations serving 700,000+ Medicaid members and driving $430M+ in revenue. Partnered with Customer Success and Member Retention and Provider Network Operations on strategic initiatives to improve member experience, provider satisfaction, and operational efficiency.
  • Key Achievements:
  • Designed and implemented KPIs to monitor enrollment impact on RPC (Revenue Per Client), ensuring sustainable growth.
  • Increased claims processing timeliness from 97.2% to 99.5% through automation and workflow redesign, reducing interest payments and enhancing provider/member satisfaction.
  • Served as SME for claims integration into a new Customer Service Tool, enabling real-time electronic communication between members, providers, and the plan.
  • Collaborated with other cross-functional teams to align claims operations with broader member engagement strategies.

Operations Manager – Claims & Enrollment Strategy

Horizon BCBSNJ
01.2016 - 01.2022
  • Directed Commercial, Medicare Advantage Claims Teams and Responsible for responding to RFPs. Collaborated with Billing and Enrollment Operations, as well as the Account Management Team to facilitate the on boarding of new groups for the purpose of on boarding of members. Demonstrated adept leadership during the unprecedented challenges of the COVID-19 pandemic, overseeing rapid policy adaptations that ensured continuity of care and compliance with evolving state and federal guidelines. Steered multidisciplinary teams to launch digital resources supporting underserved populations and leveraged data analytics to identify cost-saving measures while maintaining high-quality outcomes. Recognized for fostering a culture of innovation and accountability across operational teams, consistently exceeding regulatory benchmarks and positioning the organization as a leader in health plan operations.
  • Key Achievements:
  • Enhanced customer satisfaction by establishing clear communication channels and addressing concerns promptly.
  • Established positive and effective communication among unit staff and organization leadership, reducing miscommunications, and missed deadlines.
  • Analyzed and reported on key performance metrics to senior management.
  • Managed budgets effectively, consistently delivering projects on-time and within financial constraints.
  • Spearheaded process improvements, resulting in increased productivity and reduced operational costs.
  • Developed strong relationships with vendors, resulting in better pricing and improved service quality.

Education

MBA - Public Administration

Saint Peter’s University
Jersey City, NJ
01.2016

Bachelor of Science - Business Administration And Management

Kean University
Union, NJ
05-1995

Skills

  • Salesforce Health Cloud Google Sheets Excel

  • Claims Adjudication Platforms CRM Systems Outreach Automation Tools

  • Strategic planning and execution

  • Operations oversight

  • Operational efficiency

  • Strategic planning

  • Business management

Accomplishments

  • Achieved [Result] through effectively helping with [Task].
  • Collaborated with team of [Number] in the development of [Project name].
  • Supervised team of [Number] staff members.

Affiliations

  • National Association of Social Workers

Timeline

Director of Operations

Metro Health Plus
01.2022 - Current

Operations Manager – Claims & Enrollment Strategy

Horizon BCBSNJ
01.2016 - 01.2022

MBA - Public Administration

Saint Peter’s University

Bachelor of Science - Business Administration And Management

Kean University

Community Service

Advocate for women and children maternal health equity and culturally competent care delivery, Volunteer mentor for underserved youth and women’s health initiatives, Committed to Cayaba Care’s mission of transforming pregnancy and postpartum experiences for marginalized communities

Leadership Approach and Philosophy

Monique C. Hardy is recognized for her steadfast dedication to healthcare access and operational excellence. Her professional journey is marked by a consistent advocacy for collaborative solutions and strategic initiatives that prioritize the needs of individuals and communities. She believes that the effectiveness of any healthcare system is rooted in genuine engagement and the formation of authentic partnerships, both of which foster sustainable impacts across complex healthcare environments.

Areas of Specialization

With a strong focus on Medicaid and Commercial retention, Monique is an accomplished leader in strategic healthcare operations. She is especially skilled at community engagement, applying her expertise to ensure that care delivery remains centered on those it serves. Her approach combines operational acumen with a passion for driving meaningful change, underpinned by trust-building and data-driven strategies.

Professional Highlights

  • With over 30 years of experience in healthcare operations, Monique C. Hardy has demonstrated expertise in leading and optimizing Commercial, Medicare Advantage and Medicaid retention strategies. She is recognized for her ability to drive successful initiatives, claims management, and operational improvements across all populations.
  • Adept at building trust and collaborative partnerships, Monique excels at engaging providers, stakeholders, and internal teams to maximize member acquisition and retention. Her leadership is defined by a commitment to equitable access to care, innovative outreach, and data-driven performance management.
  • Focused on driving measurable outcomes, Monique has proven her ability to scale outreach strategies—across phone, field, and digital channels—while aligning cross-functional teams and optimizing growth funnels. Her approach places equal emphasis on strategic communications, stakeholder engagement, and effective revenue cycle management, ensuring organizations achieve sustainable performance and improved health outcomes.
  • Her passion for health equity is especially evident in her efforts to improve the medical outcomes of women and children, where she leverages empathetic leadership, bold innovation, and actionable analytics to foster meaningful change.

Executive Summary

Mission-driven healthcare executive with 30 years of experience leading high-impact operations, enrollment strategy, and claims management across Medicaid populations. Proven track record of scaling outreach and engagement initiatives, optimizing member conversion, and aligning cross-functional teams to deliver measurable outcomes. Adept at building trust-based partnerships with providers, community stakeholders, and internal teams to drive equitable access to care. Passionate about improving maternal health outcomes through data-driven strategy, empathetic leadership, and bold innovation.

Core Competencies

  • Medical Member Acquisition & Retention
  • Provider & Community Partnership Development
  • Outreach Strategy (Phone, Field, Digital)
  • KPI-Driven Growth & Funnel Optimization
  • Cross-Functional Leadership & Team Building
  • Claims Operations & Revenue Cycle Management
  • Strategic Communications & Stakeholder Engagement
  • Market Expansion & New Territory Forecasting
  • High Emotional Intelligence & Inclusive Leadership

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