Results-driven support professional with a proven track record in managing and optimizing customer service operations. Skilled in fostering team collaboration, resolving conflicts, and implementing process improvements to elevate service delivery standards. Recognized for adaptability, reliability, and a relentless focus on achieving impactful outcomes. Expertise lies in training and mentoring staff, as well as leveraging technical tools to streamline workflows and enhance team performance.
Overview
16
16
years of professional experience
Work History
Care Management Support Supervisor
Humana
06.2021 - 06.2024
Trained and developed new employees.
Identify Member needs that include but are not limited to housing, transportation, food insecurities, and additional SDoH needs.
Provide information to Members regarding finding physicians / specialists or other resources for care.
Full assistance to Care Managers including new member evaluations, meetings and community training needs.
Contributed to overall department goals and metric requirements.
Cultivated strong relationships with key clients through proactive communication and personalized attention to their unique needs.
Created a supportive environment where employees felt empowered to make decisions independently while still receiving guidance when needed.
Conducted regular performance evaluations for team members, offering constructive feedback and opportunities for growth within the organization.
Facilitated regular meetings to discuss ongoing challenges, share successes, and foster teamwork among staff members.
Senior Medical Claims Examiner
Social Security Disability
09.2020 - 06.2021
Company Overview: State of Florida
Responsible for Associate Performance management, development and engagement.
Communicated and created Associate understanding of policies, procedures, changes etc. through Team Meetings.
Improve Associate performance through daily workload monitoring, monthly performance reviews and consistence communication, when necessary, with associates about performance concerns.
Used electronic case management skills and multiple computer screens to input case notes and completed case process transactions from beginning to case closure. Including reviewing case generated alerts to ensure timely processing, written communication with claimants, medical sources and third parties.
Organized and maintained records and other reading materials related to services or benefits.
Organized and coordinated work assignments.
Used telephone and verbal communication skills to develop and establish necessary factual medical and vocational documentation.
Evaluated documents to determine their evidentiary sufficiency for decision making purposes.
Authorized the purchase of specialized medical or psychological diagnostic services, when appropriate, for the purpose of documenting the severity of impairment.
Secured medical evidence of record needed to document the presence of 'disabling' or 'not disabling' impairments.
Rendered formal decisions of disability based on evidentiary requirements of Social Security law, rules and regulations.
Mitigated risk exposure by adhering to all policies and regulations governing the medical claims examination process.
Supervisor for Eligibility Determination Unit
State of Florida
04.2008 - 05.2018
Guide unit with screening clients for eligibility for Medicaid, ICP, DDD and SSA programs for the purposes of health care.
Liaison between agency and Provider for Federal Assistance Programs.
Guide unit with tracking bills submitted from Providers for specific dates of service.
Ensure all contracts between Agency and Provider stay within financial and procedural guidelines.
Ensure work being performed by the units stays within the parameters of the Federal Government and Agency.
Enforce state and federal regulations to ensure integrity of the program.
Submit monthly reporting to Provider and Agency regarding Production and Payroll.
Monitor client case status to ensure determination of eligibility has been determined.