Business Process Specialist Resume Example Cigna Life & Health Insurance Co.

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

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

Business Process Specialist Resume Example

Resume Score: 80%

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