Overview
James Mele serves as Vice President, Core Systems Operations at MetroPlusHealth, a position held since August 2022[3]. Mele is described as a results-driven operations and application development executive with expertise in strategic planning and productivity improvement for healthcare core administration systems, including vendor management and SLA oversight[2]. Prior to MetroPlusHealth, Mele held the position of Vice President, Business Solutions at Commonwealth Care Alliance from December 2019 to July 2022[4]. Earlier roles included Senior Director of Claims Operations at Centene Corporation[5], Director of Application Development at Healthfirst[6], and Director of Application Development at Horizon Blue Cross Blue Shield of New Jersey[7]. Mele earned an MBA in Business Administration from Mount Saint Mary College in 2003[11] and a BS in Accounting and Business Administration from the same institution between 1992 and 1997[12].
Profile introduction
A results-driven and entrepreneurial thinking claims operations and application development executive with a proven ability to combine highly analytic, long-range strategic planning capabilities with consistent achievement in productivity and quality improvement for large core administration systems in healthcare servicing operations, including integrated applications and processes. Effective vendor management skills with SLA oversight. Develops strategic direction, including the process of implementing new applications and enhancing existing platforms consistent with the needs of claims ope…
Career history
- Vice President, Core Systems OperationsAug 2022 to presentMetroPlusHealth
- Vice President, Business SolutionsDec 2019 to Jul 2022Commonwealth Care Alliance
- Senior Director, Claims OperationsMar 2019 to Oct 2019Centene Corporation
- Director, Application DevelopmentMay 2012 to Apr 2018Healthfirst
- Director, Application DevelopmentDec 2008 to Mar 2012Horizon Blue Cross Blue Shield of NJ
- Team Leader - Director of CAS ImplementationMar 2008 to Dec 2008The Reserve Funds
- Assistant DirectorOct 2002 to Mar 20081199SEIU United Healthcare Workers East
- Senior Business Systems AnalystMar 1991 to Oct 2002Empire Blue Cross Blue Shield
Education
- MBA, Business Administration2003Mount Saint Mary College
- BS Accounting and Business Administration at Mount Saint Mary College1992 - 1997
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