CHARTRECE HILL
Virginia Beach,VA
Summary
Insightful Manager with experience directing and improving operations through effective employee motivational strategies and strong policy enforcement. Proficient in best practices, market trends and regulatory requirements of industry operations. Talented leader with analytical approach to business planning and day-to-day problem-solving.
Overview
19
19
years of professional experience
Work History
Operational Expert
Elevance Health
12.2021 - Current
- Applied excellent problem-solving, process development, and strategic implementation skills to lead and support all areas of operations.
- Collaborated on operational support tasks to achieve common goal.
- Set clear goals to monitor targets and offered real-time input on performance and motivation.
- Strategically coordinated operations according to objectives and capabilities, effectively allocating resources to meet demands
Provider Pay Reconsider Analyst I
Elevance Health
09.2019 - 06.2021
- Reviews and analyzes provider requests to investigate the outcome of claim payment or denial
- Determines the appropriate resolution using strict adherence to internal guidelines, policies, and procedures
- Must work with various departments, when necessary, to Determine root cause and appropriate resolution
- Remediate impacted claims.
- Resolved problems, improved operations and provided exceptional service
- Improved operations through consistent hard work and dedication
- Gained strong leadership skills by managing projects from start to finish
Customer Care Representative III
Elevance Health
06.2017 - 09.2019
- Responsible for reviewing requests by mail, telephone, or in person regarding insurance claims/policies
- Responds to inquiries from policyholders, providers and/or others for information and assistance
- Performs research to respond to inquiries and interprets policy provisions to determine most effective response
- Surpassed department goals pertaining to quality and productivity
- Serve as Subject Matter Expert (SME) to support new hire training classes
- Provides status and adjudicates claims within payment scope in Facets
- Review and research documentations in Macess
- Proficient with Microsoft products (Outlook, Words, Excel, Access)
Customer Care Representative I
Elevance Health
11.2016 - 06.2017
- Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims
- Analyzes problems and provides information/solutions
- Obtain and extract information, documents information, activities and changes in database
- Thoroughly documents inquiry outcomes for accurate tracking and analysis
- Develops and maintains positive customer relations and coordinates with various functions within company to ensure customer requests and questions are handled appropriately and in timely manner
- Researches and analyzes data to address challenges and customer service issues
- Provides external and internal customers with requested information
- Communicated with provider regarding account services, statements, and balances
Account Representative Manager
Portfolio Recovery Associates
08.2012 - 12.2013
- Managed and motivated employees to be productive and engaged in work.
- Maintained professional, organized, and safe environment for employees and patrons.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Cross-trained existing employees to maximize team agility and performance.
- Maximized performance by monitoring daily activities and mentoring team members.
- Onboarded new employees with training and new hire documentation.
Assistant Manager
Wendy's
06.2005 - 06.2012
- Supervised day-to-day operations to meet performance, quality and service expectations.
- Monitored cash intake and deposit records, increasing accuracy, and reducing discrepancies.
- Completed regular inventory counts to verify stock levels, address discrepancies, and forecast future needs.
- Offered hands-on assistance to customers, assessing needs, and maintaining current knowledge of consumer preferences.
Education
Bachelor of Science - Accounting
Norfolk State University
Associate of Science - Accounting
Everest College
Chesapeake, VASkills
- Healthcare Insurance
- Billing Adjudication
- Claim Processing
- Data integrity
- Proficient in Microsoft Office Suite
- Account management
- Understanding of medical terms
- Medicaid & Medicare processing
- Business Planning
- Staff Management
- Verbal and Written Communication
- Project Management
Affiliations
National Assoc. of Black Accountants (NABA)
Timeline
Operational Expert
Elevance Health
12.2021 - Current
Provider Pay Reconsider Analyst I
Elevance Health
09.2019 - 06.2021
Customer Care Representative III
Elevance Health
06.2017 - 09.2019
Customer Care Representative I
Elevance Health
11.2016 - 06.2017
Account Representative Manager
Portfolio Recovery Associates
08.2012 - 12.2013
Assistant Manager
Wendy's
06.2005 - 06.2012
Bachelor of Science - Accounting
Norfolk State University
Associate of Science - Accounting
Everest College
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