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SANDRA BELTON MACCHIONI

34 Madison Way, Downingtown, PA 19335


484-886-8129 (C) http://www.linkedin.com/in/sandymacchioni smad0928@westpost.n
et
PROFILE
Results driven highly effective business leader with a dedication to outstanding
customer service is seeking an opportunity to bring quick recognizable results
to your team. Through effective root cause analysis, quickly determine how best
to solve the most complex of problems using multiple tools and techniques to del
iver the most efficient results. Bring a creative yet pragmatic approach to prob
lem solving focusing on the delivery of high quality results while also demonstr
ating fiscal responsibility. Demonstrated success developing and implementing bo
th strategic and tactical plans to support the corporate vision and strategies.
AREAS OF EXPERTISE
Strategic Planning Operations / Claims
Mergers / Acquisitions / Integration Total Quality Management
Project Management (large scale initiatives) Leadership Development
Customer Service Excellence Staff Management & Development
Data Analysis
PROFESSIONAL EXPERIENCE

INDEPENDENCE BLUE CROSS


1998 to 2010
Independence Blue Crossis Southeastern Pennsylvania's largest health insurer.
Director, Integration Sr. Project Lead, Integration Planning
Corporate Strategy Planning, (2007 to 2010)
Selected by Senior Independence Blue Cross leadership to lead the integration pl
anning efforts with specific responsibility for the claims processing function.
As Director I reported to the matrixed Project Leadership, managing a team of fo
ur direct reports and numerous cross divisional reports. Assessed existing claim
s delivery model of both organizations in order to identify both synergies and g
aps to develop the best-integrated processing model allowing for the efficient a
nd effective processing of claims.
* Developed and documented the new model leveraging both organizations and indus
try best practices to define the end state processing model for the new organiza
tion.
* Identified millions of dollars in synergy savings which would be achieved thro
ugh the implementation of the new processing organizational model.
* Communicated to all stakeholders through various presentation techniques alway
s on time and with impeccable quality even given the very aggressive deadlines r
equired for the project.
Director, Claims Operations, Accounts Receivable (2001 to 2007)
Reported in to Senior Director and Vice President. Managed team of two Managers,
four Supervisors, and numerous Business Support Analysts with span of control o
f over 120 employees in delivery of high quality service to all of providers in
the tri-state area including the Professional, Facility and Ancillary providers.
Conducted root cause analysis to identify the barriers preventing the timely pr
ocessing of claims
* Developed and implemented strategic and tactical plans to substantially improv
e the claims process experience for the providers. Reducing provider accounts r
eceivables by sometimes as great as 50%
* Managed a budget of 8.6 Million
* Designed and implemented provider profile to monitor their on-going claims sub
mission performance and processing outcomes which resulted in opportunities to e
ducate the providers and substantially reduce their aged receivables by 30-50%.
* Improved significantly provider satisfaction and contract re-negotiation resul
ts. Presented frequently to healthcare providers in order to educate them on var
ious statistical approaches to problem solving. Customer feedback revealed dep
artment exceeded expectations regularly. Overall Provider Satisfaction increased
by 10-20%.
Director, Claims Operations continued
* Designed, developed and implemented an Adjustment Inventory Management softwar
e system which was able to transform paper claim inquiries into electronic forma
ts delivered to an examiner's desktop resulting in increased productivity by 40%
which is substantial savings in the millions of dollars in operating costs.
Manager, Claims Operations, (1998 to 2001)
Responsible for management of Medicaid enrollment, claims processing and member
services in a multi-state area. Managed team of 80 direct reports and three supe
rvisors.
* Established benchmarks for processing and quality standards supporting the Med
icaid business.
* Consistently exceeded all operational performance measures.
* Received the Winner Circle Award, Independence Blue Cross, 1999, 2003 - "Best
of the Best" Award, Independence Blue Cross

COMPSERVICES, INC. 1997 to 1998

Manager, Claims Operations


* Built from ground zero, a medical claims processing department supporting Work
er's Compensation administration.
* Implemented claims processing system determining resource requirements necessa
ry to be successful as well as establishing and managing a budget ensuring the s
ystem was installed on time and with defined cost parameters.
* Coordinated all resources required to ensure the success of the implementation
. Provided highest level of decision making related to all operational processes
.

EDUCATION / PROFESSIONAL DEVELOPMENT


Physician Assistant Certificate, Pennsylvania State University, Hershey, PA 19
82
Bachelor of Science, West Virginia Wesleyan College, Buckhannon, West VA 1980

PROFESSIONAL AFFILIATIONS
Academy of Healthcare Management,
Independence Blue Cross "Blue Pac" Member, 1999, 2002, 2003

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