1. JAVIER HERRERA
3184 W Foxtrotter Dr.
Meridian, ID 83646
Phone: 208-284-3633
E-mail: jeherrera01@msn.com
PROFILE
Dedicated insurance professional with 18 years of experience in the insurance industry; healthcare quality improvement
accreditation compliance project management and program management, workers compensation subrogation personal
injury liability claims management, personal lines liability claims management, health insurance sales, personal-lines
sales with an emphasis in project management and lean process improvement.
SKILLS & QUALIFICATIONS
 Experience with project management (initiating, planning, executing, monitoring and control), measurement
and benchmark methodology, regulatory oversight, and quality improvement.
 Lean process improvement principles; process mapping, change management, root cause analysis.
 Proven problem-solving and conflict management skills.
 Strong organizational skills, ability to manage multiple concurrent projects and balance competing priorities.
 Experience communicating and implementing process changes across the entire enterprise.
 Lead cross-functional teams at all levels to build strategic relationships and facilitate accountability.
 Perform business needs, gap, root cause analysis and risk management planning.
 Maintain documents and correspondence in an organized, confidential and secure manner.
 Agile and SCRUM training.
EMPLOYMENT HISTORY
Blue Cross of Idaho, Meridian ID
Accreditation Specialist (2015 - Present)
KEY PROJECTS - NCQA Accreditation Projects
 FEP Add-On Survey: 2016 FEP Accreditation survey submission is pending, and a successful accreditation
result is expected. Objective of FEP Add-On Survey is to obtain FEP product line accreditation.
 FEP Add-On Survey NCQA Scope: Management of 52 Standards, 196 Elements and 724 Factors, totaling
management of 972 fundamental components the result of 180 projects in 2016.
 Renewal Survey 2016 Readiness: Encompasses delivering of 217 projects, involving 40 standard owners
(stakeholders), large and small groups. Strong team relationship management. Project currently in the
ongoing program management phase.
 Renewal Survey 2017 Work Breakdown Structure: Work plan process mapping for ongoing accreditation
encompasses 400 projects, NCQA training and education for 40 stakeholders as the project work transitions
into the deliverable phase in 2018.
PRIMARY RESPONSIBILITES:
 Responsible for defining, planning, executing and finalizing assigned cross-functional projects and initiatives
which assure effective implementation and maintenance of health plan accreditation. Ensure compliance with
government programs, regulatory agencies and organizational policies and procedures. Assist the
organization to meet the standards, facilitate accountability and prepare for and achieve accreditation status.
Act as a resource regarding accreditation standards. Perform work within strict timeline.
 Project management networking and relationship across multiple departments; Customer Service, Medical
Management (HCO), Provider Services, Member Experiences and Corporate Communications.
 Strong understanding of Marketplace (QHP) and Federal Employee Program (FEP) product lines.

2.  Coordinate health plan accreditation for multiple lines of business through implementation of NCQA
standards. Actively partner with multiple business units to accomplish ongoing health plans certification.
 Knowledge of Star Rating for Medicare Advantage, HEDIS & CAHPS compliance, government and regulatory
agency requirements of health plans.
 Oversight of reporting accuracy, management of report outcomes, and process improvement action plans.
 Lead onsite and virtual webinar meetings for large and small groups to manage the accreditation project
submission.
 Facilitate the development of accreditation program work plans as well as supporting documentation including
communication, change management, training and formal status presentations.
 Proven leadership in team building with strong skills in training, developing, and oversight guidance.
Employers Insurance Company, Boise ID
Workers Compensation Subrogation Specialist (2009 - 2015)
KEY PROJECTS -
 EPIC IT – Four years project involvement as a beta tester, system updates, development, script testing,
system errors and production implementation impacting 7 regional office locations and 200 front-end-users.
 Subrogation Workflow: Design, execute, implement and improve a workflow process for front-end users for
subrogation claims management. Capture appropriate claims data and assign category priorities.
 Fraud Restitution Pilot: Plan, execute and identify process improvement surrounding the collection of court
ordered restitution funds on criminal fraud cases across multiple states and jurisdictions.
PRIMARY RESPONSIBILITES:
 Managing large case load; complex bodily injury claims, risk analysis, demand proposals, arbitration and
mediation claim resolution, negotiation and settlements, contract analysis, interpret and apply case law and
statute regulations across multiple states and jurisdictions.
 Subject Matter Expert – Medical Malpractice, Fraud Restitution, Premise Liability, Product Liability, Motor
Vehicle Accidents, Construction and General Negligence liability claims management.
 Proven investigative best practices – data collection, research, critical thinking, and interviewing experience.
 Experience with occupational medicine bill analysis, record evaluation, and medical terminology.
 15 years Customer Service – maintain and cultivate relationships across multiple business cultures with
internal and external customers.
 Subrogation Recovery; negotiated and settled $7.4 million.
 2015 Safety Committee Team Lead – Champion company safety initiative.
 2014 Subrogation Adjuster of the Year.
 2012 Idaho Workers Compensation Specialist Certification.
Subrogation and Claims Specialist (2000 – 2009)
Allstate Insurance Company, Boise, Idaho
 Negotiated and settled $4 million.
 2005 – 2007 Wellness Project Coordinator
 Insurance Legal Claims Principles Certification - Law of Contracts, Tort Concepts & Theories of Defense, Law
of Agency, Law of Bailment’s, Law of Damages and Law of Subrogation.
KEY PROJECTS
 Championed Health Awareness Initiatives
 Kick-Off Campaign
 Walk to Wellness
 Health Risk Assessment Roll-out

3.  Workflow initiative; generated 25% increase of settlement closures
 2008 Distinguish Top Performer Award Winner.
 2004 Innovation Award recipient
EDUCATIONEDUCATION
 Six Sigma Green Belt Certification – Villanova University 2011
 Bachelors of Science Project Management – George Fox University 2007