JOSEPH A.

TOTH

7 King Drive * Bridgewater, New Jersey 08807 * (908) 252-1353 e-mail: jt62c8
54@westpost.net
SUMMARY
An accomplished operations & project executive with 27 years demonstrated succes
s in managing, designing & implementing business process solutions streamlining
performance and improving levels of customer satisfaction in contact center, cla
ims, and mail processing operations. Expertise in operations & project managemen
t (PMO) disciplines directing multi-disciplinary project TEAM members ( PMs, BAs
, SAs / Ops Div & Vendor Reps ) in the identification and deployment of business
process solutions (via application of new technologies and/or detailed workflow
analysis & business process improvement). Knowledge of document technologies co
vering OCR/scanning, document management, corporate records retention & CTI. Pro
ven ability to manage large-scale COTS & custom-design projects applying SDLC, R
UP, AGILE, PMBOK processes involving multiple global locations. Personally hand
led over 80 various types of global & regional telecom, insurance & pharmaceutic
al business process & service delivery projects. Lead over 100 TEAM Members for
spearheading efforts to turnaround problem operations, consistently producing si
gnificant cost saving providing positive impact to the bottom line. Exceptional
communicator with extensive experience as liaison to Senior Management, Business
Operating Staff, IT, Clients & Vendors.
PROFESSIONAL EXPERIENCE
OPERATIONS
* Managed various corporate departments within health insurance organizations ov
erseeing multiple service and operations centers (contact centers, mail operatio
ns, managed care and indemnity claims adjudication). Operational size 100+ Tea
m Members.
* Forecasted business unit volumes, established area workflows & procedures as w
ell as appropriate operations budgets.
* Routinely analyzed statistical data; designed as appropriate, effective report
ing and scheduling formats to assure optimal utilization of productive work hour
s
* Designed various service improvement programs directed at enhancing service de
livery surrounding client call / mail handling
* Acted as SME on various corporate restructuring initiative programs focused at
the centralizing / decentralizing of business units
* Acted as SME on various corporate service improvement programs focused at clie
nt inquiry inventory reduction / cycle time improvements, quality control improv
ements, TEAM Member performance improvement, and new technology introduction
INFORMATION TECHNOLOGY
* PROGRAM / PROJECT MANAGEMENT
* Implemented Program Management Office to facilitate IT project implementation.
Program include the introduction of standardized forms, processes and procedure
s, phase gate reviews and approval processes to assure appropriate levels of qua
lity and assurance of meeting operational need. Managed portfolio of associated
project tracking documents (eg: WBS, project issues, UAT, ORT, training). Ensu
red adherence to master plans, schedules, and company sponsored SDLC& RUP proces
ses
* Routinely interfaced with multiple corporate departments (Underwriting, Claims
, Finance, Accounting, Marketing, Legal, IT ) to validate / update project requi
rements
* Managed various types of corporate projects involving: 1) outsourcing of serv
ices (EOB printing & mailing); 2) document re-design ( EOBs for Member & Provid
er populations); 3) claim system evaluation & replacement 4) facilities consoli
dation from corporate merger / acquisition; 5) health insurance regulatory compl
iance (HIPAA).
* Managed external 3RD party vendors / contractors (eg: EMC / Documentum, KAZEON
, Digital Reef, and COMPUWARE, ORACLE, Siebel, Computer Associates, ABF, KLIK, V
ision*R eTechnologies, Xerox,).
* Supervised PMs, BAs and SAs involving property & casualty claims, indemnity /
managed care claims, sales, telecommunications, financial, regulatory compliance
and disaster recovery initiatives
* Performed required budget planning (with the business ) to complete yearly str
ategic & maintenance budget planning for supported systems
* Regularly completed appropriate project documentation as needed ( Cost Estimat
ing, Charter, Scope, Project Plan, BRD, FRD, etc )
* Supported day-to-day break fix needs of claims processing system.
* Performed routine PM duties covering weekly monthly status reporting, expense
review, sponsor & PMO update, issue & risk management.
* Drafted & issues RFI / RFP documentation; coordinated follow-up process suppor
ting response review and vendor selection
* Supervised IT development efforts to address technical requirements to suppor
t approved projects
* Supervised review & resolution of identified Audit findings ( from internal an
d/or external reviewers )
* Managed implementation of Corporate Records Retention requirements in the IT D
ivision
* BUSINESS ANALYSIS
* Facilitated JAD sessions between the Project Sponsor, Business, IT & Vendor R
eps to identify requirements for approved projects.
* Drafted job aides / FAQ / training reference material for internal employees,
insured (patients), providers, and union officials to facilitate understanding
of upcoming process and/or technology changes
* Performed SME interviews supporting workflow / business process analysis. Draf
ted current vs. desired state processes highlighting key value adds as well as a
ssociated risks, issues, costs and staffing implications.
* Routinely worked with supported business operations to evaluate & enhance exis
ting business process, standards and controls.
* Reviewed & analyzed regulatory language to determine how to apply to business
operations
* Designed regulatory compliance program "authorization" & "verification" proces
ses ( job aides, patient communication, forms, etc.)
* Trained 600 + corporate employees in NY / NJ / CT locations via classroom and
WEB-EX training sessions on HIPAA requirements
* Authored 54 HIPAA privacy & security, policy & procedure documents to direct 1
50 + CSRs, Claims Processors, Account Executives & Union Officials on how to sec
ure claim records and to communicate with patients regarding claims processing i
ssues
JOSEPH A. TOTH PAGE 2

RECENT EMPLOYMENT HISTORY

AEGIS Insurance Services, INC
Project Manager, Claims Operations CIBERSPRING 02/09
to PRESENT
Primary responsibility for the planning & control of multiple property & casualt
y claims projects ranging from the maintenance of day-to-day system operations t
o yearly strategic projects focused at requested business enhancements approved
by the Corporate Steering Committee, Experienced in structured PMI, RUP and Life
cycle project management processes inclusive of business requirements gathering
and QA & UAT testing. Regular interface was required with Claims, Underwriting,
Sales, Accounting, Actuarial and Finance Groups. Additionally responsibilities i
nclude participating as a Member in the corporate Project Management Center of E
xcellence. Participated as well as in other broad corporate projects focused at
improvements of IT service delivery and project portfolio management (PPM) invo
lving the re-engineering of existing processes and/or the introductions of new t
echnologies. Performed a secondary role as Document Records Coordinator for the
IT Division charged with the identification, review and remediation of multiple
document types via the introduction of divisional policies & procedures defining
retention periods as well as the introduction of technologies to help implement
efficient processes. Acted as Vendor Liaison to (EMC) DOCUMENTUM / KAZEON, DIGI
TALReef and COMPUWARE.
American International Group (AIG)
Program Manager, Contact Center COE 01/08 to 12/08
Project Manager, Contact Center COE NCS TECHNOLOGIES 0
2/07 to 01/08
Primary responsibility is to work with key global operational leaders to underst
and their business issues / needs and introduce best practices, assist in the ma
turing of various operational processes, and help lead the implementation of pro
cess, procedure and program processes where none previously existed. Also mainta
ins & enhances the content of the "Contact Center - Center of Excellence" websit
e. Analyzes, recommends and generates site content. Working in conjunction with
various division SMEs, facilitates the posting of content that reinforces and he
lps achieve the mission and yearly objectives of the department. Works with var
ious corporate departments ( eBiz Services, Creative Services, etc) to maintain
functional readiness and to assure meeting corporate presentation guidelines. Re
sponsible for maintaining content & graphics library and for the general reporti
ng of metrics reflecting website activity. Facilitates the development of "campa
igns" on select topics of interest as needed. Keeps abreast of current marketpla
ce technologies and processes to maintain competitive position.
i3 Global ( an INGENIX company )
SR. Business Analyst / Business Systems Program 05/06 to 11/06
Responsible for the planning, & control of a variety of regularly scheduled and
specialized corporate projects focused at supporting the oversight and administr
ation of pharmaceutical clinical trials. Primary responsibility is focused withi
n the Business Systems Program supporting clinical trial project locations aroun
d the globe. Areas of operational focus directed at business development, resour
ce management & planning, time tracking, rate & finance administration and data
analysis. Acts as the key business contact for both project defined as well as p
roduction defined activities. Core responsibilities involve maintaining document
ation summarizing current "as-is" business operations workflows and procedures.
Creates detailed functional specification documentation supporting changes to th
e desired "to-be" environment. Work with area operations leaders to modify as ne
eded to enhance business operations efficiency. Routinely required to develop RF
P documentation supporting new business need and direction. Experience in perfor
ming "gap analysis" working across many functional departments with various leve
ls of leadership.
Amalgamated Life insurance (NYC)
SR. Project Manager(PMO) 11/04 to 2/06
Project Manager (PMO) 08/03 to 11/04
Responsible for the planning, & control of a variety of regularly scheduled and
specialized corporate projects. Acts as the corporate "process champion" to assu
re the defined objectives of improved customer service capability are fulfilled.
Directly leads a professional staff of (5) project managers with a varied backg
round in requirements development, technical & workflow analysis, business opera
tions management as well as systems development supporting the corporate custome
r service / call center, claims processing, retirement services and mail operati
ons centers in NYC, Pennsylvania, and New Hampshire. Provide guidance, support a
nd direction to select work groups comprised of a variety of administrative leve
ls up to the CEO to deliver appropriate technical solutions to fulfill the state
d objectives. Presently day-to-day liaison to the Operations Management Staff to
assure that ALL technical decisions continue to support operational needs & pri
orities. Responsible to work directly with external vendor & consultant groups a
s requested to address defined corporate objectives. Basic responsibilities incl
ude: assurance standard project management requirements / objectives are met in
cluding ;project management / reporting, workflow re-engineering, system review
& implementation, user acceptance testing, performance analysis, vendor selecti
on, model office design / management, analysis & recommendation summary, facili
tate any required system troubleshooting and training/development.
Project Manager, HIPPA Program Compliance Initiative 04/02 to 08/03
Responsible for the overall design and implementation of this regulatory complia
nce initiative. Guided corporate leadership TEAM in the evaluation of federal re
gulations to identify relevant components of privacy and security sections affec
ting business operations. Facilitated authoring, vetting and introduction of 54
new corporate privacy policies deemed necessary from the evaluation process. Imp
lemented numerous changes to corporate workflows involving the handling of telep
hone calls, claims processing and mail handling procedures for affected patient
documentation. Design 4 new privacy control forms required under the program. Dr
afted all compliance training and CSR referenced material. Delivered ALL trainin
g program for company employees.

JOSEPH A. TOTH PAGE 3

PREVIOUS EMPLOYMENT HISTORY

Computer Generated Solutions, INC 03/97 to 01/02
Project Executive, Technology Solutions Division
* Service Delivery & Operations Support VisionR
eTechnologies 07/01 to 01/02
* eStatement Practice / Business Development Initiative (In-House) 06/00
to 07/01
Assigned as in-house Project Director to provide sales support & project implem
entation assistance for eDocument presentation & scanning (OCR) solutions provi
ded by vendor partner. Primary activities included: working with VP / CTO & CG
S Senior Management TEAM to establish strategy & tactics for ongoing business de
velopment / revenue generation activities, lead generation development, manageme
nt of existing partner / client relationships, act as liaison between CGS and c
ontracted vendor partners, provide product specific training support / sales ki
ts for sales executives, conduct sales-executive "coaching" sessions for deal qu
alification / closure, identification of new market-specific business partners,
trade show coverage; web telecast product overview presentations, participate /
co-lead product presentations with Sales Executives at prospective client sites

* 401K eStatement Implementation Prudential Insurance 01/00 to 06/00

Assigned as Project Manager / Liaison between client and consulting house organi
zation to facilitate implementation of a 3RD party document management reposito
ry for Prudential client retirement account statements Project implementation re
sponsibilities were to: act as primary interface between Client, CGS and produc
t vendor to assure project objectives are achieved; assure standard project man
agement requirements / objectives are met; with the Client, develop the plan, de
fine the TEAM, provide regular project updates to both CGS & Client principals,
manage weekly TEAM status meetings, facilitate any required troubleshooting.
* Help Desk & Service Delivery Support AT&T Solutions 03/97 to 01/00
Assigned as a Project Manager to client corporate PMO Department. Assumed primar
y responsibility for a range of routine & customized technology & process improv
ement initiatives in a "tele-com" arena. Projects handled included monthly GEMS
platform (change ) releases, corporate Y2K inventory, assessment & remediation
initiative, as well as routine business improvement initiatives thru workflow r
evision and/or introduction of new technologies in the Global Client Support Cen
ter ( Help Desk ).

Amalgamated Life insurance (NYC) 06/96 - 03/97

Project Manager, Medical Claims Scanning Implementation
06/96 to 03/97
Responsibilities included acting as a primary liaison between the claims divisio
n and 3RD party technology integrator (PMI Imaging Systems) and scanning solutio
n provider (Optika).on various project initiatives focused at the enhancement of
internal business process and overall service delivery thru the introduction o
f document management technologies (eg: scanning, OCR, workflow, CTI, bar-coding
, etc) . Services provided include various project-oriented elements as: proje
ct management / reporting, workflow re-engineering, system review and implement
ation, user acceptance testing, performance analysis, vendor selection, model of
fice design / management, analysis & recommendation summary, and training/devel
opment. Relevant systems background in ACD and OCR / document scanning technolo
gy.

Empire Blue Cross & Blue Shield, New York, NY 1986 - 1996
Operations Project Manager, Document Management Services 10/95-6/96
Responsibilities included acting as a 'corporate liaison' between various corpor
ate departments and XEROX vendor on various project initiatives involving the us
e of document scanning, OCR, workflow, and document management, and call center
technology. Major activities included: requirements gathering, business analys
is, vendor / product analysis, and analysis & recommendations summary.
Account Director / Team Leader, Consumer Markets / Small Group Accounts Call Cen
ter Operations 8/94-10/95
Responsibilities included: start-up and maintenance of a region-specific account
book-of-business call center operation involving 4200 small group accounts (inv
olving app. 30,000 customers); directed 20 professional staff members handling s
ales, account management, retention, and benefits related issues.

JOSEPH A. TOTH PAGE 4

Empire Blue Cross & Blue Shield, New York, NY CONTINUED 1986
- 1996
Director , Customer Service / Call Center Operations 12/92-8/94
Responsibilities included: maintenance of the corporate office call center depar
tmental operations and staff training/development to provide for timely and accu
rate resolution of 1.2 million incoming customer calls received yearly; directed
five supervisors (114 total TEAM members) handling membership and benefit-relat
ed questions inclusive of house operators and corporate fraud hotline. Concurr
ently managed corporate rollout / introduction of scanning, OCR, workflow, CTI
technology applications within the call center.
Manager, Correspondence Support Services Department 12/91-8/94
Responsibilities included: maintenance of departmental operations and staff trai
ning/development to provide for the timely and accurate routing of 650,000 Custo
mer Service Division inquiries as well as the retrieval of any associated corpor
ate microfilm claim records. Directed (four) supervisors (45 total TEAM members)
handling routine individual customer, group administrator and provider inquirie
s.
Primary responsibility focused at the design & implementation of a corporate 'mo
del office environment' to facilitate the introduction document retention / trac
king technology in the Customer Service Division (eg: scanning, OCR, workflow, e
tc) . Acted as primary liaison between the division and scanning solution provid
er (Sigma Imaging Corporation).
Manager, Benefits Administration 8/86-12/91
Responsibilities included: maintenance of departmental operations and staff trai
ning/development to provide for the timely and accurate resolution of 390,000 in
coming claims-related inquiries; directed three supervisors (45 total TEAM membe
rs) responding to customer-related claim adjustment inquiries. Participated as
a division representative in various corporate business planning meetings focus
ed at improvement of service delivery thru the introduction of new process techn
ology (eg: inquiry tracking, document retention, call processing, performance re
porting, etc).

Blue Cross & Blue Shield of New Jersey, Inc.

Lead Assistant Operations Manager, Customer Service/Call Center Operations 6/
83-8/86
Responsibilities included: maintenance of a business unit TEAM and staff trainin
g/development within an incoming customer call center operation, directed one su
pervisor (35 total TEAM members) responding to membership and benefit-related ca
lls.

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CERTIFICATION
Masters Certificate
Applied Project Management
Villanova University
OPERATIONAL SKILLS
* project plan development * Status, metrics reporting * budgeting & forecasting

* sponsor & stakeholder expectation management * executive, business operations,

and IT liaison
* business analysis *, requirements management,* workflow documentation,/ proce
ss reengineering
* Test plan creation & execution * Scope, schedule, & change management
* Relationship building,/client satisfaction management * Vendor management &
contract negotiation * Risk identification & mitigation * Success criteria defi
nition & validation planning
* critical path and dependency identification * project management * SDLC * PMI
* RUP * AGILE * UAT
* operations management * content management * website design & maintenance *
outsourcing
DATABASE & OPERATING SYSTEMS
ORACLE, SQL, DB2, Unidata, Sybase, WebSphere, Windows, Unix/AIX, MVS, VSE
TECHNICAL SKILLS
Proficient PC skills utilizing:
Microsoft WORD, Microsoft POWERPOINT, Microsoft EXCEL, Microsoft PROJECT, HTML
COMMUNITY ACTIVITY
Participated as a Junior Mentor for the Junior Achievement Program (NYC)
President, Stratton Meadows Homeowner Association, Bridgewater, New Jersey (199
9 to 2003)
EDUCATION
Monmouth College, West Long Branch, NJ
Bachelor of Science Degree, Business Administration
(concentration in management & finance)