BLUE CROSS BLUE SHIELD OF ILLINOIS, Chicago, IL             Apr 2002 – Present

BCBS of Illinois is the largest insurance company in Illinois; it provides health insurance for more than 14 million individuals in the U.S.  BCBS of Illinois is a division of Health Care Service Corporation (HCSC), which also operates through its Blue Cross and Blue Shield plans in Montana, New Mexico, Oklahoma, and Texas. 

Office of the Chief Information Officer (OCIO) & Innovation Services

Senior Project Leader                            Sep 2012 – Present

Accountable for developing and executing Annual Planning and Metrics for IT division.  Help guide cross-functional teams to gather necessary data using industry best practices and benchmarks.  Assist Innovation area with research and/or ROI/potential savings calculations on new technology initiatives.  Collaborate with community partners to expand ITG/HCSC footprint in local areas.  Assist Office of CIO members in creating department plans, communication plans, and organizational change management plans.

Notable contributions:

·   Work with IT and Business leadership to develop shared Annual Performance Incentive (API) goals for HCSC.

o   Track and monitor API goals on monthly basis.

o   Frequently inform CIO and VPs on progress or status changes.

·   Create and maintain IT metrics and dashboards.

o   Present to CIO at staff meetings on monthly basis.

o   Provide rigorous assessment of the accuracy, validity and reliability of data gathered for reporting.

o   Refine and improve data gathering and reporting mechanisms.

·   Create and execute organizational change management, communication and training plans for high profile projects.

o   Evaluate data, employee behaviors and expectations.

o   Participate in brain-storming sessions to set vision and leadership alignment.

o   Recommend best communication methods to reach various audiences.

o   Create communication and training timeline to compliment the overall project timeline for successful transformation.

·   Coordinate with internal teams to complete industry surveys focused on IT.

o   Analyze survey data and investigate opportunities for internal improvements.

o   Present results to IT leadership on annual basis.

·   Lead project management functions for various ad-hoc projects working with internal and external teams.

o   Responsible for determining project scope, liaising between teams throughout project lifecycle, and ensuring objectives were met.

o   Track and help mitigate issues and risks

o   Track and report project milestones and deliverables

Analytics and Information Management (AIM)

Senior Analytics Consultant              Mar 2008 – Sep 2012

Implemented new strategies to meet the increasing demand from BCBS members and clients for additional metrics and reporting data which are used to enhance existing products and to develop new healthcare products.  Defined and managed metrics by collaborating cross-functionally within BCBS.  Collaborated with product development and information technology to create new healthcare products which reduce costs for employers while offering better care for members.  Determined which data and metrics are needed to measure the risk associated with and results for new products.

Notable contributions:

·               Managed information and reporting solutions to help maximize the value of HCSC care management offerings to both internal and external clients.

o Designed and distributed Wellness Reports to strategically monitor utilization for the Tobacco Cessation and Weight Management Programs.

o Acted as a primary liaison between technical teams, internal departments, external clients, and vendors; translate customer information/data needs into actionable requirements.

o Supported BCBS leadership by creating granular reporting to enhance data analysis to determine the success of key wellness programs designed to improve the overall health of members.

·               Served as a subject matter expert and as a liaison to vendors and internal teams to gather consistent data and determine the best process for integrating data from multiple disparate sources in order to create consistent reporting metrics.

o Educated internal departments and vendors about data quality and reporting processes.

·               Served as project manager for the Quarterly Care Management Project including planning the project and timeline, estimating resources, and analyzing data. 

o Developed the look of the Quarterly Care Report, conducted analysis, and ensured accuracy of data.  The report is submitted quarterly to more than 600 employer groups. 

Health Care Management Provider Contracting & Reporting

Senior Reimbursement Specialist                Jan 2005 – Feb 2008

Served as a liaison to hospitals regarding their contracts with BCBS. Calculated and forecasted contracted provider rates and ensured that rates were in compliance with contract terms; adjusted claims to ensure that payments were made according to contract. Adjustments ranged from small amounts to $9 million for larger hospitals.

Notable contributions:

·               Created analytical tools which enabled analysis based on historical reimbursement data and supported the contract negotiation process.

·               Migrated the contract tracking process from paper-based to electronic to create transparency in the process, reduce payment errors, and reduce time required to process contracts. 

o Developed databases used to compare, track, and report contract data and corresponding dates to ensure that reimbursements were paid according to negotiated contract terms. 

o Shared database with multiple departments and trained employees to utilize the electronic tool

o Designed user friendly graphical interfaces for Microsoft Access databases and automated data extraction/ generation processes through expert use of Visual Basic for VBA.

·               Served as a member of the team which created a process for identifying which member hospitals were in compliance with National Provider ID regulation after its enactment.

Health Care Management, Quality Improvement

Quality Research Analyst             Apr 2002 – Dec 2004

Communicated with BCBS members and network providers to ensure the quality of Blue Cross managed care products.  Audited, surveyed, and conducted data analysis to determine areas of improvement for HMO and POS products.  Oversaw delegated vendors for HMO, POS, and PPO products; reviewed quality improvement information and quality reports. 

Notable contributions:

·               Conducted quarterly hospital patient survey and a corresponding primary care (PCP) physician survey; survey results were used to rank hospitals and to improve hospital performance and service for both patients and doctors. 

o Designed the survey tool, collaborated with a team to create survey questions, and planned and administered the survey. Compiled and communicated survey results.

·               Created detailed Quality Improvement Activity Reports as required by the National Committee for Quality and Assurance (NCQA) accreditation.

·               Designed and maintained the Quality Improvement Workplan used to collect data and create reports for senior management.

·               Developed and executed an annual bi-lingual paper-based survey of 50,000 members and reported results to senior BCBS leadership.  Survey data was used to make key decisions regarding products and services.

o Coordinated survey content, worked with fulfillment centers to coordinate implementation, and led a team of support staff to gather the results. 

COMBINED INSURANCE COMPANY OF AMERICA, Glenview, IL             Nov 1999 – Jul 2001

Combined insurance is a private provider of accident, health, and life insurance products.  The company was named to the Ward Group’s annual list of “50 Top Performing Insurance Companies” for 2010.

Actuarial Technician, Health Pricing

Filed annual Medicare Supplement rate filings, collaborated with State insurance departments to obtain approval for products and pricing, and conducted statistical analysis on health insurance products.