DAVID RICK WATKINS
Walton
Summary
Dynamic, results-driven professional with a proven track record in personnel management and team leadership. Adept at navigating complex challenges through effective conflict resolution and performance evaluation. Expertise in employee development and fostering a collaborative environment that enhances team synergy and drives organizational success. Renowned for adaptability, consistently achieving organizational goals while adjusting to evolving business landscapes. Committed to cultivating an inclusive workplace culture that empowers individuals and maximizes productivity.
Overview
22
22
years of professional experience
Work History
Customer Service Manager 1
Elevance Health
06.2020 - 11.2025
- In this position, I led a customer service and claims team to enhance resolution rates and improve client satisfaction. Fostered a positive work environment, focused on teamwork and collaboration. Conducted regular performance reviews, providing constructive feedback to enhance team capabilities. Assessed performances to determine training needs, and define accurate plans for decreasing process lags. Took ownership of customer issues and followed problems through to resolution. Analyzed customer feedback to identify trends and recommend service improvements. Managed escalated customer issues, ensuring timely resolution and maintaining client relationships.
- Collaborated with cross-functional teams to streamline processes and enhance operational efficiency. Conducted regular performance evaluations for team members, identifying areas for improvement and creating targeted action plans. Kept accurate records to document customer service actions and discussions. Optimized workflow processes to maximize efficiency while maintaining an unwavering commitment to client satisfaction.
- Fostered culture of continuous improvement, leading to consistently high service standards. Tailored training content to meet specific needs of customer service representatives. Maintained a professional demeanor by staying calm when addressing unhappy or angry associates or customers. Evaluated employee performance and conveyed constructive feedback to improve skills.
- Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement. Successfully managed budgets and allocated resources to maximize productivity and profitability. Cultivated positive rapport with fellow employees to boost company morale and promote employee retention. Controlled resources and assets for department activities to comply with industry standards and government regulations. Leveraged data and analytics to make informed decisions and drive business improvements.
Claims Resolution Analyst Senior/ Appeals Coordinator
Anthem Blue Cross and Blue Shield
03.2004 - 06.2020
- In this position, I oversee Provider Appeal Associates to monitor and coordinate daily workflow utilizing available resources to ensure case files are completed accurately and timely. Train, coach and counsel associates regarding proper steps and/or areas needing improvement. Audit associate provider appeal case files. Serve as a liaison between associates and manager as well as provide input for associate evaluation. Assist with interviews and hiring of new Provider Appeal Representatives. Review internal audit trends assessed by auditing team and review with staff. Take Supervisor calls when required. Proven to effectively adapt to changes quickly and able to respond to concerns verbally or in writing. Facilitate weekly roundtable meetings including creating agenda for topic discussions. Encourage associates to participate in question and answer session to offer input. Create Access IT tickets for associates when required. Complete or review OPM appeals before uploading to web base application for Office of Personnel Management. Field questions from Process and Operations Experts regarding appeals procedures.
- Additional areas of experience in this role include communicating with Members, Providers, Office of Personnel Management (OPM), Director's Office/Member Services, Medical Director, Clinical Staff, Legal area, Managers, Leads and Customer Service Representatives for appeal resolution as required. Reported monthly quality scores to associates and manager. Coordinated member reconsiderations to ensure completed timely. Oversaw and or worked escalated issues from CEO and Concierge inquiries. Oversaw/monitored incoming mail to ensure appeals and medical records are routed correctly.
Grievance/Appeals Representative I-II
Anthem Blue Cross and Blue Shield
01.2005 - 01.2008
- Reviewed member correspondence to determine member reconsiderations. Gathered information related to reconsideration case. Analyzed claim processing, as well as researched benefits to determine correct benefit provisions applied to claims processing. Requested additional information to make appropriate determination on reconsiderations. Adjusted or keyed claims to apply correct benefits. Created and/or implemented spreadsheets to aid in reconsideration via word or excel. Created formal written response to member upon completion of reconsideration upholding or overturning original payment decision.
Customer Service Representative I-II
Anthem Blue Cross and Blue Shield
01.2004 - 01.2005
- Answered customer inquiries pertaining to benefits and claim status. Entered individual calls using Customer Service pop up application (detailed call). Ensure claims were processed correctly using FEP guidelines. Adjusted claims when needed using Streamline, QCare and or FEP Direct programs. Advised claim status via call or correspondence to member or provider. Ensured policy information is correct via patient information screen on computer. Updated member information when needed. Answered correspondence inquiries through phone calls and letters. Ensured timeliness met on open inquiries in personal inquiry out box.
Production floor personnel Supervisor and Planner
- Prior to joining Anthem, I was a production floor personnel Supervisor and Planner where I effectively managed floor personnel by prioritizing and developing daily and weekly production plans and schedules. Updated employee files and conducted performance reviews. Ensured time accuracy for products built and logged associate time sheets. Created Excel spreadsheets for CEO and staff, as well as managed production orders and participated in daily production meetings. Resolved production issues and talked with internal and external customers via telephone. Inventoried material on hand and issued material for manufacturing orders via computer system.
Education
High School -
Boone County High School
Florence, KentuckyNo Degree - Business Administration And Management
Western Governors University
Salt Lake City, UTSkills
- Experienced with various software applications Microsoft Office Suite, Streamline system, WGS, FEP Direct system
- Employee onboarding
- Employee engagement strategies
- Staff development
- Performance improvement
- Employee motivation strategies
- Team building
- Multitasking Abilities
- Excellent communication
- Active listening
- Strong interpersonal skills
- Professionalism
About me
Collaboration is key to success in what you are wanting to achieve. I am a people person that loves to motivate others to see their full potential. In my spare time I am an avid cook and baker.
Additional Training
Anthem Future Leader Program – 2016/2017
Timeline
Customer Service Manager 1
Elevance Health
06.2020 - 11.2025
Grievance/Appeals Representative I-II
Anthem Blue Cross and Blue Shield
01.2005 - 01.2008
Claims Resolution Analyst Senior/ Appeals Coordinator
Anthem Blue Cross and Blue Shield
03.2004 - 06.2020
Customer Service Representative I-II
Anthem Blue Cross and Blue Shield
01.2004 - 01.2005
Production floor personnel Supervisor and Planner
High School -
Boone County High School
No Degree - Business Administration And Management
Western Governors University