Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. I strive to create an atmosphere that encourages and cultivates growth, ideas, and collaboration to build and maintain positive relationships with colleagues and external stakeholders. I pride myself in taking an innovative approach to problem solving while developing evidence-based, data driven solutions with a people first mindset. I provide an exceptional client experience through a proactive approach with effective, transparent, and easy communication. I have ten years of experience in the health insurance industry establishing, managing, and maintaining positive relationships with members and the provider network to allow proactive successful partnering on business initiatives and client objectives.
Overview
13
13
years of professional experience
Work History
Network Operations Manager – Network Management Team
Wellmark Blue Cross and Blue Shield
Des Moines, Iowa
05.2016 - Current
Curious, motivated self-starter with strong organization, time management, and prioritization skills
Flexible and adaptable to change
Subject matter expert on credentialing and contracting criteria
Experience with self-insured health plans
Experience with both small and large group member benefit plans
Experience with building out unique provider networks specific to Joint Venture and ACO networks and benefit plans
Forward thinking approach and strategic vision to build out networks and benefits in conjunction with and compliant to evolving healthcare regulations and laws
Excellent oral and written communication skills; the ability to articulate information into relevant, actionable insights, identify business implications and provide recommendations to varying audiences in a consumable format
Strong collaboration and relationship building skills fostered through 10 years of experience in the healthcare industry using strong interpersonal skills to promote group facilitation, collaboration, and teamwork
Lead the implementation of new technology, new network structures, and the implementation of new market products
Lead the project to implement new credentialing system
Knowledgeable of regulatory industry standards such as NCQA, URAQ, and the Joint Commission
Develop and conduct internal facing and external facing webinar presentations pertaining to business priorities and client objectives
Demonstrate innovative approach to business priorities and ability to manage change with effective use of process development, improvement, and support execution
Development of monthly dashboard of data to identify trends, develop educational opportunities for both internal and external stakeholders and evaluate workflows and processes
Passion for process excellence to establish work standards to provide transparent communication and exceptional service
Initiate and leverage collaboration with both internal and external stakeholders on time sensitive, escalated issues to reach quick resolution.
Customer Service Associate
Wellmark Blue Cross and Blue Shield
Des Moines, Iowa
08.2013 - 05.2016
State of Iowa Customer Service Team
Provider and member service in both self-funded and fully insured member benefit plans
Experienced with both small and large group benefit plans including national accounts
Enhanced the customer experience through education and enabling effortless quality communication
Assisted members with active employee and retiree enrollment information, billing inquiries and benefit application
Researched and analyzed claim information and member inquiries providing accurate timely response
Educated group retirees on benefit plan coordination with Medicare.
Territory Relations Manager
American Income Life
06.2011 - 08.2013
Develop a team of ten agents to maintain and exceed sales goals
Provider training and coaching surrounding products and sales procedures
Cultivate a positive atmosphere to inspire team to develop their best selves leading to higher engagement and enthusiasm.
Education
Bachelor of Science in Healthcare Administration -
Purdue University Global
05.2017
Skills
Reporting and Documentation
Critical Thinking
Microsoft Office
Project Management
Attention to Detail
Motivated Self Starter
Provider Network Administration and Credentialing
Teamwork and Collaboration
Relationship Management
Skilled communicator
Timeline
Network Operations Manager – Network Management Team
Wellmark Blue Cross and Blue Shield
05.2016 - Current
Customer Service Associate
Wellmark Blue Cross and Blue Shield
08.2013 - 05.2016
Territory Relations Manager
American Income Life
06.2011 - 08.2013
Bachelor of Science in Healthcare Administration -
Assistant Manager - Professional Services and Product Development, Infrastructure and network management at Tata Communications Payment Solution Ltd.Assistant Manager - Professional Services and Product Development, Infrastructure and network management at Tata Communications Payment Solution Ltd.
Team Lead Network Operations Support at MainOne Cable Company, FABAC Centre, VITeam Lead Network Operations Support at MainOne Cable Company, FABAC Centre, VI
Designed, coded, tested, debugged, and migrated components of a Front-End application, using the following ISPF Dialog Manager Tools: Panels, Messages, Tables and Skeletons, along with REXX Execs, which facilitated Subject Matter Expert’s (SME’s) identification and extraction of Endevor elements, to prepare for transfer to a LINUX-based system named, “Informatica”. SMEs used Informatica to prepare the downloaded element’s flows to identify technical debt, so that the Agency could migrate away from, what it considered, Legacy development languages. This was due to the shrinking pool of expertise and availability of Legacy Language talent pool.Supplied support to many other mainframe developers, via a tool called Workbench from Allen Systems Group (ASG).The tool was a Data Resource Management System (DRMS) Facility, which provided a repository for and management of COBOL, HLASM, and CICS development metadata. Also managed by the tool were various other elements, such as user access, and Dynamic Table Access Management (DTAMS).Using JCL, REXX, Endevor, TADz, Workbench, and CyberFusion on the mainframe and UltraEdit, MS Access and Excel on the Network, developed a very extensive and complex spreadsheet, for a Tech 14 to evaluate and ultimately present to the Associate Commissioner and other higher-level SSA management. The spreadsheet was a depiction of the overall scope and effort that needed to transition from Workbench (SSA no longer received support for the product), and it aided the Tech 14 in his future presentation.Coding, testing, debugging, and migrating programs (HLASM/COBOL/CICS/Db2/IMS), routines, copybooks, and macros, in support of multiple applications across the Agency.Created and maintained numerous ISPF REXX and CLIST scripts.Created and updated Standard Operating Procedures (SOP) and User manuals, using M365 Tools, including VISIO Pro.Created and supported many MS Access and Db2 SQL scripts, to access and update related databases and tables.Involved in the testing of zOS Multi-Factor Authentication (zMFA), which supplanted Single Sign-On (SSO) at the Agency. zMFA provides multiple levels of authentication and thus, greater levels of security.Participated in Daily Stand-ups/Weekly/and Monthly and other Agile-Related meetings on multiple Teams.Maintained Team SharePoint sites (pages) which later were ported to Confluence. at Leidos, Inc., for Social Security AdministrationDesigned, coded, tested, debugged, and migrated components of a Front-End application, using the following ISPF Dialog Manager Tools: Panels, Messages, Tables and Skeletons, along with REXX Execs, which facilitated Subject Matter Expert’s (SME’s) identification and extraction of Endevor elements, to prepare for transfer to a LINUX-based system named, “Informatica”. SMEs used Informatica to prepare the downloaded element’s flows to identify technical debt, so that the Agency could migrate away from, what it considered, Legacy development languages. This was due to the shrinking pool of expertise and availability of Legacy Language talent pool.Supplied support to many other mainframe developers, via a tool called Workbench from Allen Systems Group (ASG).The tool was a Data Resource Management System (DRMS) Facility, which provided a repository for and management of COBOL, HLASM, and CICS development metadata. Also managed by the tool were various other elements, such as user access, and Dynamic Table Access Management (DTAMS).Using JCL, REXX, Endevor, TADz, Workbench, and CyberFusion on the mainframe and UltraEdit, MS Access and Excel on the Network, developed a very extensive and complex spreadsheet, for a Tech 14 to evaluate and ultimately present to the Associate Commissioner and other higher-level SSA management. The spreadsheet was a depiction of the overall scope and effort that needed to transition from Workbench (SSA no longer received support for the product), and it aided the Tech 14 in his future presentation.Coding, testing, debugging, and migrating programs (HLASM/COBOL/CICS/Db2/IMS), routines, copybooks, and macros, in support of multiple applications across the Agency.Created and maintained numerous ISPF REXX and CLIST scripts.Created and updated Standard Operating Procedures (SOP) and User manuals, using M365 Tools, including VISIO Pro.Created and supported many MS Access and Db2 SQL scripts, to access and update related databases and tables.Involved in the testing of zOS Multi-Factor Authentication (zMFA), which supplanted Single Sign-On (SSO) at the Agency. zMFA provides multiple levels of authentication and thus, greater levels of security.Participated in Daily Stand-ups/Weekly/and Monthly and other Agile-Related meetings on multiple Teams.Maintained Team SharePoint sites (pages) which later were ported to Confluence. at Leidos, Inc., for Social Security Administration