LiveCareer
LiveCareer
  • Dashboard
  • Jobs
  • Resumes
  • Cover Letters
  • Resumes
    • Resumes
    • Resume Builder
    • Resume Examples
      • Resume Examples
      • Nursing
      • Education
      • Administrative
      • Medical
      • Human Resources
      • View All
    • Resume Search
    • Resume Templates
      • Resume Templates
      • Nursing
      • Education
      • Medical
      • Human Resources
      • Customer Service
      • View All
    • Resume Services
    • Resume Formats
    • Resume Review
    • How to Write a Resume
    • CV Examples
    • Resume Objectives
  • Cover Letters
    • Cover Letters
    • Cover Letter Builder
    • Cover Letter Examples
      • Cover Letter Examples
      • Education
      • Medical
      • Human Resources
      • Customer Service
      • Business Operations
      • View All
    • Cover Letter Services
    • Cover Letter Templates
    • Cover Letter Formats
    • How to Write a Cover Letter
  • Jobs
    • Mobile App
    • Job Search
    • Job Apply Tool
    • Salary Calculator
    • Business Letters
    • Job Descriptions
  • Questions
  • Resources
  • About
  • Contact
  • 0Notifications
    • Notifications

      0 New
  • jane
    • Settings
    • Help & Support
    • Sign Out
  • Sign In
Member Login
  • LiveCareer
  • Resume Search
  • Business Process Specialist
Please provide a type of job or location to search!
SEARCH

Business Process Specialist Resume Example

Resume Score: 80%

Love this resume?Build Your Own Now
BUSINESS PROCESS SPECIALIST
Professional Summary
Highly skilled process improvement specialist with many years of health insuranceadministration expertise. Expert in designing user-friendly training and learning modules and translating operational and client needs into tangible solutions.
Skills

Process Improvement

Training

Operations Assessment


ProjectManagement

Business Analysis


Work History
Business Process Specialist, 03/2015 to Current
Cigna Life & Health Insurance Co. – Bloomfield, CT
  • Implemented Prevue 3.0 project designed to improve the case management referral process to ensure customers were routed appropriately based on identified care needs
  • Decreased the rate of misdirected referrals from 14% atproject inception to 5% post go-live
  • Worked with frontline staff to assess tool performance and implement logic and process changes to provide optimal efficiency during use
  • Designed standard reporting presentations to provide leadership team with consistent updates, enabling informed decision-making and real-time operational assessment
  • Created time study tools for multiple teams to monitor and measure baseline and pilot performance
  • Virtually trained associates on the use of the time study tool and addressed questions post-training
Senior Project Manager, 01/2014 to 03/2015
Amerigroup, Inc. – Hanover, MD
  • Documented, monitored and tracked all deliverables for the 2014 VBP Adult Program to achieve successful completion of the project goals established by Health Plan leadership team
  • Partnered with Senior Medical Director and Quality Manager to develop and implement strategies to engage member and providers, ensuring care was received and coordinated, resulting in improved health outcomes
  • Worked with departmentsubject matter experts(SMEs) to assess the performance of implemented activities and initiatives, and recommend improvements where appropriate
  • Created and maintained department SharePoint site used for storing team projects, training materials and standard templates
Director, Project Management, 10/2010 to 12/2013
Amerigroup, Inc. – Hanover, MD
  • Project managed cross-functional Plan-wide programs including Health Equity Cultural Competency Initiative, Clinical Programs Initiative and Data Management Initiative
  • Implemented project management model throughout the Healthcare Management Services (HCMS) department to provide consistent project implementation guidelines and process templates
  • Educated staff on new and revised operational protocols using PowerPoint presentations and Visio process maps
  • Developed HCMS SharePoint site housing reports, educational materials, project tracking system, department updates and incoming work and support request templates
  • Assisted HCMS leadership in outlining training needs and developing a plan for onboarding new team members, including FACETS system training and process training on authorization entry
Director, Compliance Policy and TrainingDesigned and, 01/2009 to 09/2010
WellCare, Inc. – Tampa, FL
  • Designed and facilitated Corporate Compliance training online modules for all associates, approximately 4000 employees
  • Developed and implemented strategic and operational vision for Policy and Training department
  • Assisted inaddressing 200+Internal Action Plans to ensureclosure of all CMS identified operational deficiencies that led to the suspension of Company enrollment and marketing activities
  • Managed completion of OIG and Deloitte audits designed to demonstrate compliance with Medicare and Medicaid program guidelines
  • Revised and consolidated Corporate policies, providing the framework for a more streamlined policy administration model
  • Worked with Senior Leadership and outside counsel on responding to terms of Deferred Prosecution Agreements and CMS Sanctions Notification
  • Conducted Compliance portion of training for newly hired Company associates
Education
Bachelor of Science: Management, 2003
University of Maryland University College - Adelphi, MD
  • Emphasis in Behavioral and Social Science
MBA: Marketing, 2005
Walden University - Baltimore, MD
Build Your Own Now

DISCLAIMER

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

Companies Worked For:

  • Cigna Life & Health Insurance Co.
  • Amerigroup, Inc.
  • WellCare, Inc.

School Attended

  • University of Maryland University College
  • Walden University

Job Titles Held:

  • Business Process Specialist
  • Senior Project Manager
  • Director, Project Management
  • Director, Compliance Policy and TrainingDesigned and

Degrees

  • Bachelor of Science : Management , 2003
    MBA : Marketing , 2005

Create a job alert for [job role title] at [location].

×

Advertisement

Similar Resumes

View All
Business-Process-Analyst-resume-sample

Business Process Analyst

QuintilesIMS

Milwaukee, Wisconsin

Sr.-Business-Process-Engineer-resume-sample

Sr. Business Process Engineer

Ferrili Information Group

Milwaukee, Wisconsin

Business-Process-Manager-resume-sample

Business Process Manager

Chase Card Services

Sanford, Florida

About
  • About Us
  • Privacy Policy
  • Terms of Use
  • Sitemap
Help & Support
  • Work Here
  • Contact Us
  • FAQs
Languages
  • EN
  • UK
  • ES
  • FR
  • IT
  • DE
  • NL
  • PT
  • PL
Customer Service
customerservice@livecareer.com
800-652-8430 Mon- Fri 8am - 8pm CST
Sat 8am - 5pm CST, Sun 10am - 6pm CST
  • Stay in touch with us
Site jabber winner award

© 2021, Bold Limited. All rights reserved.