Mary Jo Zeise

2225 Samantha St. #42

DePere, WI 54115
(920) 632-7511 home
(920) 362-4390 mobile

May 2010

To Whom It May Concern,

I would like to submit my credentials for consideration for a position within your organization. My
diverse background, health insurance industry experience, dental field experience, and hands-on
personal nature would allow me to enjoy and be successful in this uniquely challenging
opportunity.

I am a claim operations manager with over 17 years of experience in various disciplines within
the insurance industry including health claim adjudication, customer service (call center),
electronic data interchange, provider contract repricing, claim data capture, and claim imaging
and archival. I also possess a very strong dental background, with over 11 years experience,
that includes complex operative procedures in an extensive range of the dental spectrum, in
addition to the exclusive administration of a comprehensive, health oriented patient consultation
program closing with the detailed delivery of focused treatment plans and financial
arrangements.

Some of my strengths are motivational personnel direction, detailed procedural conception,

implementation and management and troubleshooting. My strong organizational, interpersonal,
leadership and communication skills have helped me be successful in many different roles in my
career.

My broad skill set, motivation and flexibility separate me from other managers. I am able to
perform well in various capacities, including project leadership, process design and
implementation, and hands-on testing and troubleshooting. In addition to being able to work
independently, I work very well in a team environment, and have a proven record in a leadership
role.

With my background in the health insurance industry and dental field, in addition to my natural
detail oriented aptitude and leadership abilities, your company will benefit from my ability to see
the big picture as well as focus on the many details of a quality driven, customer focused
environment.

Please feel free to contact me at your convenience to discuss opportunities in more detail. I look
forward to hearing from you.

Best regards,

Mary Jo Zeise

Mary Jo Zeise – Resumé

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 MARY JO ZEISE
2225 Samantha St. #42
DePere, WI 54115
(920) 362-4390
mzeise@sbcglobal.net

OBJECTIVE and PROFILE

A well-rounded professional with excellent relationship management and problem solving skills, a wide range of
abilities and proven history managing resources, deadlines and multiple priorities, while creating partnerships to
achieve aggressive goals seeking an opportunity to fully utilize a diverse background and broad skill set.

Over 17 years of experience (15 of those years in a supervisory/managerial capacity) within the insurance industry
working with medical, vision, and dental claim adjudication, customer service (call center), electronic data
interchange, provider contract repricing, claim data capture, claim imaging and archival, with the insight and ability to
excel as a manager, leader, troubleshooter and problem solver.

Over 11 years of experience in the dental field with an extensive knowledge of complex procedures. Worked
cooperatively with the dentist practitioner as well as individual execution of pre- and post-operative procedures and
diagnostics, and administration of a Oral Health Program, concluded by my delivery of comprehensive treatment plans
involving TMJ disorders, prosthodontics, periodontics, and orthodontics in addition to “routine” restorative processes.

AREAS OF EXPERTISE

 Cross Functional Team Leadership  Business Requirements Development

 Policy Development and Implementation  Training and Development
 Internal/External Partnerships  Staff Recruitment

PROFESSIONAL EXPERIENCE

CLAIM MANAGEMENT SERVICES, INC./ANTHEM BLUE CROSS BLUE SHIELD, Green Bay, WI
1992- 2010
Third Party Administrator for employer self funded medical, vision, dental, disability plans

Manager, Claim Operations

Managerial effectiveness in this diverse environment is critical to understanding the needs of the customer, client plan
designs, applicable systems and processes, and the development and sustaining of a functional working relationship
within the organization. In this position I utilized a combination of hands on personnel coaching and management,
project management, procedural design and implementation, troubleshooting and problem solving abilities. I worked
in conjunction with claims, billing and enrollment, provider maintenance, internal technologies, and outside data
capture and archival vendors to identify detailed process requirements and execution.

 Recruited, trained and developed staff for cross functional teams.

 Managed teams with the following disciplines: medical, vision, dental and short term disability claim
review and adjudication, customer service, preferred provider claim repricing, data capture, electronic
claim load review and issue reconciliation, claim imaging and archival, inbound mailroom.

 Worked independently and with outside consultants regarding medical and dental procedure pre-
authorizations for the determination of medical necessity and appropriateness, benefit determinations,
benefit appeals, claim adjustments and refunds, subrogation reviews and pre-existing condition
determinations.
Mary Jo Zeise – Resumé
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  Expanded and maintained the company’s customer service, claim adjudication, and claim directional
processes (electronic claim receipt and forwarding, including internal processes and external vendors)
resulting in reduced business cost, improved functional efficiencies, and reduction of claim turn around
time.

 Developed and implemented claim imaging, data capture, and archival processes with two outside
vendors. Served as the company business contact with these vendors for issue resolution, additional
process improvements and invoice confirmation.

 Responsible for the telephony aspect (created phone trees and messaging, directed vectoring, and
completed testing) for 36 client dedicated lines in conjunction with the migration of the company to an
upgraded adjudication platform.

 Created an internal Coordination of Benefits (COB) manual and trained members of Billing and Enrollment
on the COB process.

 Key contributor in the composition, implementation and update of the Company Business Continuity Plan
Manual.

 Member of the Company Emergency Response Team (trained on CPR and AED), Safety and Security
Council, Associate Giving Committee, and award winning Associate Engagement Committee.
 Excellent individual and team quality, customer feedback, personal and managerial effectiveness, and
associate engagement scores are the result of dedicated efforts to successfully work projects and execute
processes and procedures , while understanding the needs of the customer.

Positions held within the Claim Management Services, Inc. organization prior to Operations Manager are, in descending
order, Assistant Manager, Supervisor, Assistant Supervisor and Claim Representative. I held my initial position of
Claim Representative for 2 years prior to my promotion into a supervisory role. In that position I:
 Adjudicated medical, dental, and short term disability claims for dedicated employer groups
 Provided customer service for dedicated employer groups
 Conducted pre-existing condition investigations
 Reviewed pre-authorization requests and determined benefits for dental and dental related medical
procedures for the entire client population of CMSi.

CYRIL J. VAN SISTINE, DDS, DePere, WI

1988-1992
Dentist Practitioner- General

Dental Chairside Assistant

• Interactive chairside assisting (operative, surgical, periodontal and endodontic).

SCOTT N. QUANDT, DDS, Green Bay, WI

1977-1983
Dentist Practitioner with focuses on Prosthodontics, Periodontics, Endodontics, Orthodontics and TMJ disorders

Expanded Duties Dental Assistant

• Interactive chairside assisting (operative, surgical, periodontal, orthodontic, TMJ, prosthodontic, and
endodontic). Surgical included hospital surgical tech duties.

• Performed pre- and post- operative procedures (including obtaining vitals and administering nitrous oxide and
monitoring patient response), diagnostics (diagnostic casts; intra and extra-oral x-rays including
cephalometric, panagraphic, bitewing, periapical; “traced” cephalometric x-rays; Hanou articulator
measurements; fit and inserted temporary and pediatric deciduous crowns (resin and stainless steel); created
and inserted space maintainers, flat plane bite splints, and orthodontic retainers; changed orthodontic arch
wires; and miscellaneous dental laboratory procedures.

• Maintained office inventory, dental material purchasing, and new product review with dental product supplier.

• Office OSHA coordinator.

Mary Jo Zeise – Resumé

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 • Singularly administered a comprehensive Oral Health/Patient Consultation Program involving nutritional and
oral health counseling, treatment plan presentation, and financial arrangements. In addition to “routine” oral
care and restorative, I received continued education and consulted on TMJ disorders (surgical and non-surgical
options), prosthodontics, periodontics, and orthodontics.

Additional prior employment history includes Schneider National (Claims Dept.), Dr. James V.
Petersen (Dental Chairside Assistant), St. Vincent Hospital (Medical Records Dept.),
Montgomery Ward Co. (Retail Sales). Information is available upon request.

EDUCATION
Northeastern Wisconsin Technical College, Green Bay, WI – Associates Degree, Dental Assisting
1973-1974

Certification

American Dental Association and American Dental Assistant Association – Certified Dental Assistant (CDA)
designation

1974

PROFESSIONAL DEVELOPMENT
Technical Applications

Oracle PeopleSoft
Microsoft Applications: Word, Excel, PowerPoint, Office Communicator, Outlook
Avaya Phone System Reporting
AccuTerm/FACTS Claim Adjudication System

Other Training and Seminars: On-line Courses (continued):

Service Mentor Coaching (09/2005) Limited English Proficiency (LEP) (01/2007)

American Health Insurance Plans (AHIP) Fundamentals of
Health Insurance (05/2006)
Disney Institute Customer Service (05/2006)
Senn Delaney Leadership, Teambuilding & Culture Change
Seminar (04/2006)
Associate Culture Shaping Workshop (07/2006) – Acted as
a manager facilitator
On-line Courses:
Security –Protecting PHI (04/ and 10/2004)
Fraud and Abuse Awareness (10/2005)
Standards of Ethical Business Conduct (09/2005)
Workplace Harassment Awareness for Supervisors and
Managers (11/2005)
2006 HIPAA Privacy Policy Changes (02/2006)
Emergency Response Procedures (10/2006)
Ethics and Compliance Certification (09/2006)
Health Care Fraud and Abuse (10/2006)
Improving Your Image (05/2006)
Mary Jo Zeise – Resumé
The Emergency Response Leader (06/2007)
Asserting Yourself Professionally (05/2008)
Dynamics of Leadership (10/2008)
Enhancing Listening Skills (12/2008)
Ethics & Compliance and Fraud & Abuse (08/2008)
Etiquette for Supervisors (12/2008)
Introduction to Procurement (05/2008)
Leadership Exchange and Expo (06/2008)
Managing Diversity and Inclusiveness (10/2008)
Workplace Diversity (09/2008)
Advocacy – What Every Employee Should Know
(06/2009)
Breach Notification- Privacy and Security Disclosure
(09/2009)
Emotionally Intelligent Leadership (12/2009)
Equal Employment Opportunity (EEO) Compliance
(02/2009)
Ethics & Compliance and Fraud & Abuse (08/2009)
Handling Difficult Calls: Customer Service Advocates
(06/2009)
Leadership Exchange and Expo (10/2009)
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Anthem Blue Squared (11/2007)
Building Relationships to Get Results (11/2007)
Consumerism 101 (04/2007)
Culture and Behavior (11/2007)
Fraud and Abuse (11/2007)
Mastering the Call Flow (03/2009)
Microsoft Office Communicator (02/2009)
Equal Employment Opportunity (EEO) Compliance
(01/2010)

REFERENCES
Connie Polasik, RN, BSN, CCM Marilyn J. Bortel
Manager of Medical Management (Former) Senior Vice President
Arise Health Plan Claim Management Services, Inc.
Phone: 920-490-6970 1610 Berkshire Drive
Fax. 920-490-6943 Green Bay, WI 54313
Connie.polasik@wpsic.com mletrob@new.rr.com
Home: (920) 498-1707
Deborah Roth Cell: (920) 621-7532
Program Director, Migration & Systems Retirement
WellPoint Corporation Mary Davis
3 Huntington Quad Sr. Implementation Lead
Melville, NY 11747 Central/West Accounts
Deborah.Roth@Empireblue.com Anthem National Accounts
Work (631) 577-4324 mary.davis@anthem.com
Work: (513) 336-5131
Diane Duranceau Cell: (513) 265-3136
(Former) Project Manager, Commercial Business
WellPoint/Anthem Blue Cross Blue Shield Michelle Bosacki
2452 Peshtigo Street Manager, Customer Care Multi
Green Bay, WI 54313 CMSi & Anthem Blue Cross Blue Shield
dcdurance@new.rr.com 975 Hansen Road
Cell: (920) 265-8163 Green Bay, WI 54304
Home: (920) 405-9991 mbosacki@cmsins.com
Work: (800) 472-7130 ext. 1163
Javad Qadir Cell: (920) 660-8537
Tech Project Director
WellPoint Corp. Pamela Hazod
975 Hansen Road Human Resources Manager
Green Bay, WI 54304 Anthem Blue Cross Blue Shield
jqadir@cmsins.com 6775 W. Washington Street
Work: 920-529-1302 Milwaukee, WI
Cell: (920) 639-3113 Pamela.Hazod@bcbswi.com
Work: (414) 459-6945
Jeff Swiggum
Infrastructure Services Analyst ll Stephanie Baker
CMSi/Anthem Blue Cross Blue Shield Sales Account Rep lll Consultant
WellPoint Corporation National Central Account Management/Anthem BCBS
jswiggum@cmsins.com 2700 Vernon Drive
Work: (920) 569-1286 Green Bay, WI 54304
Cell: (920) 360-7376 Stephanie.baker@anthem.com
Work: (800) 472-7130 ext. 1195
Jennifer Mann
Project Manager Tera Nelson
National Account Control Migrations Account Manager Consultant
WellPoint Corporation Wisconsin Large Group Sales/Anthem BCBS
Jennifer.B.Mann@wellpoint.com 975 Hansen Road
Phone (920) 246-2253 Green Bay, WI 54307
tera.nelson@anthem.com
Work: (920)569-1105
Personal Cell: (920) 737-9756
Mary Jo Zeise – Resumé
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Mary Jo Zeise – Resumé
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