Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas

Senior Manager, Business Solutions Strategy & Operations

Cambia Health Solutions

•	Nominated for a 2020 Cambia Value Award in the category of Collaboration
•	Develop business architecture strategy, leveraging an end-to-end view of the business and an understanding of strategy, capabilities, people, processes, technology, and governance
•	Define information flow and work flow to clarify and/or improve accessibility and efficiency
•	Develop and refine business strategy and roadmaps in partnership with leadership and multiple business areas
•	Provide direction to and actively participate in project teams, executing roadmap components
•	Designed and implemented Internal Performance Testing and Consumer Obsession Programs, generating operational metrics, feedback, and Voice of the Customer to the business

Business Architect

• Deliver concierge services through a cross-functional team of professionals, supporting B2C products, B2B products, and incubating pilot programs to test feasibility, value, and growth potential.
• Lead the development and execution of concierge service delivery including overseeing and creating processes, setting standards, and establishing systems to ensure quality and service excellence.
• Develop meaningful metrics that showcase value while managing the day-to-day operations with an emphasis on service quality, efficiency, and an elevated customer and consumer experience.
• Handle all management responsibilities including budgeting, staffing, workforce management and optimization, hiring, performance management, and employee development and retention.

Manager, Concierge Services

•	Nominated for a 2018 Cambia Value Award in the category of Commitment
•	Designed and implemented the first-generation multi-channel contact center using contracted customer service resources to support a product platform combining technology with human-delivered concierge services
•	Drove the evolution of a second-generation model service desk, in-sourcing from the previous version while up-leveling the skillset and competencies to support an evolving product platform, including a staffing model to cover 24/7
•	Managed continuous improvement of business capabilities including feasibility, compliance, regulatory, and value assessments to implement first-in-kind services within market, operational, and regulatory constraints
•	Contributed to creation of strategic business operations roadmaps, aligning with Product, Engineering, and Consumer Experience
•	Lead business strategy and operations activities, including defining business requirements, prioritization of capabilities, and system and process development
•	Directed activities, resources, teams, processes, and systems to meet business, product, and financial goals
•	Established business metrics; monitored and tracked performance to continuously improve systems and processes
•	Lead cross-functional teams to conceptualize and design innovative solutions, consulting as necessary with external sources and agencies during design and implementation phases
•	Assured alignment of operational processes and goals with the overarching Product, Consumer Experience, and strategic platform goals
•	Holistically navigated and partnered with the domains of the technology stack, product management, sales, marketing, consumer engagement, and finance in actively managing business operations

Senior Program Manager

Responsibilities & Accomplishments:
- Developed a structured product implementation framework to manage the effective delivery of third party products to market.
- Translated product strategy and business development activities into actionable implementation steps and drove the product through its due diligence.
- Validated and monitored product value through a multi-faceted, cross-functional evaluation tool.
- Drove products through Legal considerations, including medical care versus non-medical care, Wellness Program versus Employee Assistance Program, regulatory and filing requirements, Privacy requirements, and contract development.
- Coordinated the adherence to Cambia Infosec requirements by third party products, including physical and electronic data security, access controls, and privacy and compliance safeguards.
- Drove cross-functional teams to solve for multi-party billing, resulting in a consolidated third party bill which included several complex tax implications (sales tax, income tax, and premium tax) for both the employer/customer and the end-user.
- Coordinated customization of third party products, including program components and the digital experience (both mobile and web).
- Prepared the product for Sales and Marketing activities, including training, collateral, and marketing and activation plans.

Implementation Manager, Sr

Projects:
- Medical Management System Implementation (Pega)
- Clinical CareAdvance Upgrade (4.61 to 5.x)
- Health Care Services Project Portfolio

Responsibilities:
- Lead 2-3 cross-functional agile teams (25-30 people) through definition and development using Scrum, Kanban and Pega SmartBPM methodologies
- Leverage Pega PRPC and BPM values to iteratively drive a Lean, integrated, and automated market-competitive medical management system
- Maintain the release roadmap and product backlog, prioritize and groom features for development by agile teams, and provide subject matter expertise and decision-making during sprints

Product Owner

Projects:
 - 3 Organizational Restructures
 - Quality Audit Program
 - 3 Preauthorization Bundles
 - Enhanced Concurrent Review Program
 - Telephony Reconfiguration

Responsibilities:
 - Supervised non-clinical staff that provided operational and administrative support to utilization management programs, care management programs, Provider Services initiatives, claims processing functions and customer service
 - Implemented and improved business processes including system configuration, benefit and reimbursement policies, workflows, and claims pricing, adjudication and payment integrity
 -  Supported enterprise projects including URAC accreditation, legislative implementations, benefit implementations, and Accountable Care Organizations

Supervisor, Clinical Operations

Projects:
 - Oregon Parity Benefit Implementation
 - Federal Parity Benefit Implementation
 - 90808 Outlier Management Program
 - Oregon Provider Network Tiers

Responsibilities:
 - Developed and administered training for department staff on products, systems and processes
 - Researched member benefits, provider contracts, legislation, business requirements and system configuration to support pricing initiatives, utilization management objectives, and provider utilization trends
 - Defined new and applied lean process improvement to existing departmental workflows and processes

Behavioral Health Program Associate

Sur La Table

Responsibilities:
- Created and trained a product knowledge and selling guide for associates
- Designed and implemented sustainable store cleanliness and maintenance program
- Lead sales through Holiday (October through December 2005) with 11% of total store sales compared to the average of 5%

Operations Lead

Starbucks Coffee Company

Responsibilities:
- Achieved sales of 113-116% to budget for Second and Third Quarter 2005, kept expenses below budget
- Propelled Second Quarter lunch sales to highest margin in Pacific Northwest Region through waste reduction and effective sales techniques
- Analyzed business trends to establish appropriate PAR levels, reorganized inventory using Lean methods for emphasis on speed of service and safety and security standards
- Strategic scheduling of staff resulted in growth of business and reduction of labor costs
- Raised corporate compliance of under-performing store 29 points to 95% in approximately two months through situational leadership, re-implementing operational standards, and translating corporate vision to staff
- Coached deployment standards, resulting in a 10% increase in transactions per hour
- Earned first Coffee Master Certification in district, then mentored others to successful certification
- Organized and delegated daily assignments and duties appropriate to business needs to provide an optimal environment for customers and employees
- Promoted from barista to shift supervisor after six months; promoted to assistant store manager after one year

Assistant Store Manager

•	Experienced leader with a passion for designing and executing meaningful experiences through operational excellence, building high-functioning teams, leveraging technology, and developing people
•	Expert ability conducting analysis of complex problems and processes, architecting options and solutions, and prioritization of action plans at various organizational levels
•	Thorough understanding of and experience developing and applying both predictive and adaptive frameworks for Business Process Management, Project Management Life Cycle, Product Management Life Cycle, Software Development Life Cycle, and Change Management
•	Experienced applying Lean and Six Sigma process improvement principles to retail, production offices, and system design
•	Software and technologies:  Salesforce, Pegasystems PRPC, MS Office, MS Project, ActiveCollab, Rally, Jira, Confluence, SharePoint, Visio, LucidChart, Aha!, SQL

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