MISTY A.

MOSELEY
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1209 Oak Street McKinney, TX 75069
214.585.1999-C 214.544.0011-H/W
mm500818@westpost.net

SENIOR BUSINESS PROCESS OPERATIONS

Top performing professional with 9+ years experience in contract issuance, case
installation of benefits, and business operations. Dynamic self-motivated team
player and leader with an unparalleled work ethic and track record of meeting ag
gressive goals for increasing market share, revenues, and client base. Strong r
elationship builder, highly capable of partnering with clients, vendors, staff,
and administration. Knowledgeable of contractual interpretation as it relates t
o system integration and end user groups both internal and external.
Customer Service Research/Basic Systems Installation Implementation Process
Improvement
Operations Management Project Management Policy/Procedure Development Start-U
p Operations
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CAREER ACHIEVEMENTS
* Instituted 200 new templates from the original 5-iBAAG templates that had been
developed, which allowed our company to support 10 new products that were filed
with all states Department of Insurance.
* Developed and tested templates to remove a cost on average per year of $624K,
while also reducing the amount of line staff that would be required from 60 FTEs
to 30 FTEs.
* Built a database for the department that contained all the legal binding fully
insured contract documents for our reference to insure iBAAGs and TOPS models w
ere in compliance with the legal documents.
* Recouped $80K in incorrect claims due to invalid third party vendor reimbursem
ent schedules.
* Averaged 100% of the clients supported had performance guarantees associated w
ith benefit accuracy and claim readiness by effective date.
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PROFESSIONAL EXPERIENCE
UnitedHealth Group Incorporated Richardson, TX 1998-Present
Project Manager 2002-Present
Developed product integration plans for system of all major/minor contractual f
ilings including medical, vision, and consumer driven products.
Built strong matrix of Subject Matter Relation contacts with Product Owners, Co
ntract Specialist and Information Technology and downstream areas such as produc
tion staff, customer care professionals to deliver Quality Six Sigma project for
iBAAG (Internet Benefits at a Glance installation.)
Conduct business plan analysis/feasibility studies for major new medical produc
t offerings both fully insured requiring approval by state insurance department
agencies and Self Funded contracts.
Conduct cost benefit analysis CBAs for all strategic projects.
Produced operational models for implementation process for the Key Account busi
ness segment (i.e. groups with 50 to 4 thousand lives) for upper management.
Built business solutions based on HD trends reporting to reduce error reported
ratio versus critical metrics for implementation have been reduced 40% over the
past eight quarterly metrics reports.
Written, maintained and contributed to over 400 Standard Operating Procedures i
n support of the New Project and revisions to projects.
Developed test/use cases for all key deliverables most recently for system enha
ncements needed for Federal Legislation revisions to the Final Rules under the P
aul Wellston and Pete Domenici Mental Health Parity and Addiction Equity Act of
2008.
Developed system Analysis documents and Business Requirements documents for key
stakeholder sign off of all system enhancement projects including major and min
or new product offerings or system enhancements.
Designed process flows using Visio for workflow management resulting from new P
roduct Initiatives.
Engaged in modeling simulation to gain create efficiencies at the process and p
roduction level.
Sr. TOPS Analyst 1999-2002
Attended weekly Account Management Teams to insure benefit concerns, changes, e
tc were kept up to date and accurate on the TOPS claim payment platform for both
fully insured and self funded business.
Responsible benefit build of 120 accounts primarily focused on the Colorado and
Texas markets with a mixture of Strategic Accounts (i.e. groups of 4 thousand o
r more lives.)
Required complete knowledge of all standard UHG product offerings, legislative
mandates for Texas and Colorado mandatory versus mandatory offerings to facilita
te compliance of benefit build on the UNET system.
Introduced a new process of obtaining the certificates of coverage e.g. legal b
inding documents for all states and built a database for my team to have pre-bui
lt iBAAGs and TOPS models that were compliant with state and federal mandates.
Sr. Contract Specialist 1998-1999
Created the contract documents fully insured and self-funded for 50 clients.
Responsible for production of all riders, amendments, certificates of coverage,
summary plan descriptions, financial renewal agreements, administrative service
s agreements and comparative analysis of externally produced summary plan descri
ptions for groups that produced their own documents.
CENTRA Benefit Services, Inc. Plano, TX 1994-1998
Customer Service Specialist
Responsible for call volume of 100+ per day and complex claim adjustments and a
udits for a 40k membership Self Funded Union/Salaried Steel Company.
Met with Union reps weekly to resolve claim/customer complaints.
Represented unit monthly on the executive meetings with the group.
Confed Admin Services, Inc. Tucson, AZ 1993-1994
Customer Service Specialist
Responsible for call volume on medical and dental benefits for 80 clients.
Processed claim adjustments and stop pay/reissue of checks for claim payment.
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EDUCATION:
Bachelor of Arts-Political Science, University of Arizona, Tucson, AZ