Blue Cross And Blue Shield Of Florida Work Values

Daily Duties at Blue Cross And Blue Shield Of Florida:

BLUE CROSS & BLUE SHIELD OF FLORIDA (BCBSF) 1988–2009 Increasing responsibility with a leading provider of health insurance products. Received severance and vested retirement in a major corporate reorganization that eliminated the “New Markets” organization (below). Director, New Markets, 2008–2009 Established separate and distinct operational capabilities for the newly created “New Markets” organization, which was designed to operate outside the traditional BCBSF operations by developing and executing low-cost products for the uninsured and under-insured markets in Florida. Assembled and led the newly formed organization to develop new products for an organization that was typically slow in developing new products in response to shrinking membership arising out of a slowing economy. • Led the development of BCBSF’s first non-insurance product, a medical discount card, conducting a full risk-management analysis and selecting vendors to manage what became “Family Blue,” now marketed in both Spanish and English statewide via retail outlets. • Developed pricing models, benefits structures and provider networks for services ranging from hospital and physician care to dentistry and supplements, assured that telemarketing, enrollment, customer service, and billing infrastructure were in place. • Built to 2,000 members in the first six months and projected revenue at 3 years of $5M. Senior Manager, Transaction, Planning & Management, 2003–2008 Supervised a team of 10 to 12 responsible for all front-end services, including imaging and claims data capture, as well as claims processing, adjudication, and customer service. Identified appropriate domestic, near-shore, and offshore vendors; negotiated contracts; defined service-level agreements (SLAs); led projects to implement initiatives; monitored the work of vendors and implemented improvements. • Served as the Lead Business Analyst for TRICARE bid development and presentation and wrote the enrollment and billing bid response and infrastructure map for the Department of Defense. • Developed a strategy for Business Processing Outsourcing (BPO) that led to annual savings of approximately $10M, the largest portion resulting from electronic and international data capture. • Qualified vendors and negotiated BPO master services agreements with such vendors as IBM, ACS, and Perot Systems; monitored agreements and assured that 100% of performance metrics and SLAs were in compliance. CALVIN F. HOCH PAGE 2 BLUE CROSS & BLUE SHIELD OF FLORIDA (CONTINUED) Manager, Other Party Liability (OPL), 2001–2003 Directed OPL organization, which identified primary, secondary, and tertiary liability and performed OPL-recovery activities. • Led a staff of more than 175 supervisors, team leaders, customer service associates, and quality analysts in all recovery activities, which yielded more than $40M in OPL savings and $12M in subrogation recoveries annually. • Consolidated the Subrogation Department to double annual cash recoveries in the first year. Project Consultant, State Account Operations (SAO), 1999–2001 Requested to assume responsibility for this section, which had lost and subsequently recovered the State of Florida group account, to design and implement operational enhancements resolving critical performance and audit issues for the Department of State Group Insurance (DSGI. • Led multiple teams in Operational Effectiveness, Quality Assurance, and Medial Review to assure appropriate procedures and controls were in place. • Recontracted with the PricewaterhouseCoopers to keep audit costs constant, saving $120,000. • Achieved quality and productivity goals that successfully avoided penalties and responded effectively to audit findings. Manager, Federal Employee Program (FEP), 1995–1999 Led a FEP Claims and Customer Service organization of more than 200 to serve a base of more than 130,000 contract holders and 260,000 members. • Consolidated the Claims and Customer Service operations to build a Total Customer Care unit that achieved an increase in first-call resolutions of approximately 20% and a corresponding reduction in annual costs. • Received FEP incentives of $100,000 to $200,000 annually, which contributed to the budget and employee bonuses of up to $100,000., Senior Methods Analyst, FEP, 1993–1997 Led multiple teams of professionals in Quality Assurance, Customer Service Training, and Operational Effectiveness. Forecast and prepared annual budgets and operating plans, chaired the Corporate Rewards and Recognition Work Group, and Led the Performance Management Process Work Group. Supervisor, FEP Claims Adjudication Team, 1988–1993 EARLIER SIGNIFICANT EXPERIENCE 1980–1988 Sold HMO products for two years and served as a Prudential District Agent in Jacksonville for six years. EDUCATION JACKSONVILLE UNIVERSITY B.S., CUM LAUDE, BUSINESS ADMINISTRATION, 1999 LICENSURE • National Association of Securities Dealers (NASD), Series 6 (not active) • Florida Property & Casualty License; Florida Health & Life License (not active) CONTINUING EDUCATION • BCBSFL Leadership & Development Training • Train the Trainer: Certified in Customer Service & Front-Line Leadership, Achieve Global

What they like about Blue Cross And Blue Shield Of Florida:

Organizations with strong, centralized leadership are particularly attractive to you. You require a work environment with leadership that aggressively seeks to expand and grow the business and does so in a visible and decisive manner. In general you prefer to work in an environment in which there is a strong link between leadership, its actions, and a strong set of company-wide values.

Tags

Director, Manager, Project Management, Business Lead, Compliance, Risk Assesment

Skills

Strategic Planning • Operations Management • Federal & State Contracting Product Development • Vendor Qualification • Bid & Proposal Development • Sales Presentations • Staff Development • Leadership • Team Building • International Outso

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