Moses Bethune
Hamden
Summary
- Professional with over 17 years of experience in account management, project management, claims processing, and call center operations across insurance and retail sectors. Proven ability to identify customer needs and align them with suitable product offerings, resulting in enhanced customer satisfaction. Demonstrated success in implementing reporting procedures that minimize errors and improve service quality. Skilled in data analysis, project management, and proficient in Microsoft Office, JIRA, MS SQL Server, and SAS.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Business Consultant
ANTHEM BCBS “Anthem Blue Cross & Blue Shield”
Wallingford
01.2020 - Current
- Support a single operations department by participating in project and process work responsible for translating moderately complex and varied business needs into application software requirements. Possesses full technical knowledge of most phases of systems and business analysis and is able to consider the business implications of the application of technology to current and future business environments.
- Train and Lead teams of analysts that are assigned to complex projects.
- Determines specific business application software requirements to address complex and varied business needs.
- Analyzes and designs solutions to address complex and varied business needs.
- Consults with business partners concerning application and implementation of technology.
- Builds support for business change throughout the business unit and cross functionality.
- Design methods for integrating function and processes.
- Creates and maintains databases to track business performance. Designs methods for integrating function and process, Strong analytical, organizational, presentation, and problem-solving skills.
- Analyzes data and summarizes performance using summary statistical procedures. Develops and analyzes business performance reports (e.g., for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
- Creates and publishes periodic reports, as well as any necessary ad hoc reports.
- Expertise in taking business issues and devising best practices in developing appropriate diagnostic and tracking data that will translate business requirements into usable decision support tools.
- Tracks and prioritizes projects through coordination and negotiation with internal and external clients to improve the efficiency of information/project plan generation.
- Performs strategic data analysis (data mining) and research as appropriate to support business needs.
- Experience with relational databases and knowledge of query tools and statistical software.
- Ability to manipulate large sets of data.
- Conducts training on the use of applications.
- Strong business analytics and project management experience.
- Expertise Working in Subrogation Prod, SIT, UAT and DEV environments.
- WGS, NASCO mainframe experience.
- ...Continued…
Process Expert II
ANTHEM BCBS “Anthem Blue Cross & Blue Shield”
01.2014 - 01.2020
- Support a single operations department by participating in project and process work in the Commercial and Specialty Business Division. Interpret different forms of management-related information in Anthem to help management solve problems and improve our company's efficiency.
- Research operations workflow problems and system irregularities
- Develops, evaluates, presents process improvement solutions for new systems, new accounts, and other operational improvements.
- Develops and leads project plans and communicates project status; and performs other duties as assigned.
- Provides process direction and decision making for all minor and major project work.
- Provide guidance to other process experts.
- WGS, NASCO mainframe experience.
Benefit Structure Analyst
ANTHEM BCBS “Anthem Blue Cross & Blue Shield”
01.2010 - 01.2014
- I’m responsible for translating basic business information into application software; work directly with coordinators to ensure that work is processed and completed in a timely manner. Work hard to maintain and increase service levels to both internal and external customers. Work closely with sales departments to process and key groups on system as well as ensure that we have correct information so that members are not impacted in a negative manner, clarify information, and research kick outs and reports to ensure all members are up on system correctly. Gather, analyze, and report daily/weekly/monthly caseloads.
- Interpreting, translating, coding, and testing group benefits to system capabilities.
- Interprets contract language and translates to system.
- Determines what is loaded to the file and the most efficient use of those files.
- Reviews workflows to ensure those administrative processes promote correct interpretation of benefits.
- Received outstanding positive comments from team members on employee reviews, as well as exceptional feedback from Management and coordinators.
- Serves as resource to other operations associates for claims payment procedures and contract coverage. Performs other duties as assigned.
National Business Customer Service Rep III
ANTHEM BCBS “Anthem Blue Cross & Blue Shield”
01.2008 - 01.2010
- Respond to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims. Proficient in all basic customer service areas.
- Instrumental in improving customer-satisfaction ratings through suggestion, development and taking our members and providers out of the middle.
- Work with other BSBC plans, to assist with getting our members and providers issues resolved in a timely manner.
- Work on managing other BCBS plans concerns that are sent to us via email, researching their questions and emailing them results from questions and concerns that they have.
- Assist team with work on systems that I have not been trained on in order to maintain our customer satisfaction and close cases in a timely manner.
- Assist in keying claims and scanning documents in Ultera system and setting up cases to be worked to resolve problems that other plans may have. With local plans and self-funded groups
Customer Service Rep II
ANTHEM BCBS “Anthem Blue Cross & Blue Shield”
01.2007 - 01.2008
- Team Player in daily call center operations. Collaborate with Customer Service Manager to create strategic plans to enhance customer satisfaction. Work hard to maintain and increase service levels to both internal and external customers. Work closely with other departments to maintain customer satisfaction, clarify information, and research claims status. Gather, analyze, and report daily/weekly/monthly caseloads.
- Dramatically enhanced customer-satisfaction ratings by expediting all claims and ensuring a high degree of accuracy
- Instrumental in improving customer-satisfaction ratings through suggestion, development and taking our members out of the middle.
- Contact providers on behalf of our member, to assist with getting our members issues resolved in a timely manner.
- Work on managing customers concerns that are sent to us via email, researching their questions and emailing them results from questions and concerns that they have.
- High volume mailings of literature and information needed to advance members knowledge about their health care policy.
Education
Doctoral Degree - Divinity
St Thomas Christian University
01.2020
Bachelor’s degree - theology
CLBC
New Haven01.2012
Associate degree - religious studies
CLBC
New Haven01.2011
Skills
- Microsoft Office (Word, Excel, PowerPoint, Visio) Adobe Illustrator, Photoshop, Acrobat Professional Salesforce SQL, JIRA SQL and SAS Query experience Engage in analysis Project management working knowledge of mainframe computer, hardware, and operating systems With Agile project experience
Certification
- Completed 12-week customer service course at Anthem Blue Cross and Blue Shields
- Successfully completed three-week mentoring program.
- Completed three-week call coaching class
- Successfully Completed ethic and compliance classes
- Completed 2009 Nasco System Training
- Completed 2015 WGS System Training
- Project Management: Understanding PM Tool Certificate of Completion 2023
- PMP Bootcamp Certificate of Completion 2023
- Database Fundamentals Certificate of Completion 2023
- Preparing and Implementing a Business Plan Certificate of Completion 2023
- Yellow Belt Six Sigma and Lean: Foundations and Principles Certificate of Completion 2023
- Six Sigma Green Belt Organizational Goals and Six Sigma Certificate of Completion 2023
Timeline
Business Consultant
ANTHEM BCBS “Anthem Blue Cross & Blue Shield”
01.2020 - Current
Process Expert II
ANTHEM BCBS “Anthem Blue Cross & Blue Shield”
01.2014 - 01.2020
Benefit Structure Analyst
ANTHEM BCBS “Anthem Blue Cross & Blue Shield”
01.2010 - 01.2014
National Business Customer Service Rep III
ANTHEM BCBS “Anthem Blue Cross & Blue Shield”
01.2008 - 01.2010
Customer Service Rep II
ANTHEM BCBS “Anthem Blue Cross & Blue Shield”
01.2007 - 01.2008
Doctoral Degree - Divinity
St Thomas Christian University
Bachelor’s degree - theology
CLBC
Associate degree - religious studies
CLBC
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