Summary
Overview
Work History
Education
Skills
Affiliations
Training
References
Timeline
Generic

DELPHINE JOHNSON

Jacksonville,FL

Summary

Dynamic Lead Operations Analyst with expertise in project management and employee relations. Proven track record in optimizing operations and implementing quality assurance protocols. Adept at problem analysis and fostering employee engagement, driving cross-functional collaboration to achieve strategic objectives. Committed to a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

Overview

37
37
years of professional experience

Work History

Lead Operations Analyst

Evernorth/Cigna
Jacksonville, FL
09.2021 - Current
  • Coordinated cross-functional projects involving multiple teams from start to finish.
  • Supports and provides direction to more junior professionals. Works autonomously, only requiring “expert” level technical support from others.
  • Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.
  • Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends within business operations.
  • Lead project steps within a broader project, or have accountability for ongoing activities or objectives.
  • Responsible for preparing and reviewing key statements and documents related to business operations.
  • Presented findings to management and executive leadership and fielded questions to help refine strategies.
  • Ensure that production levels and targets are achieved, and effective processing controls are in place.
  • Established quality assurance protocols for evaluating operations performance against established standards.
  • Implemented effective communication strategies between internal teams as well as external vendors and clients regarding operational matters.
  • Ensured proper documentation is maintained for all operational activities including changes made in systems and processes.
  • Maintained a comprehensive understanding of industry best practices related to operational management.
  • Led cross-functional teams in developing strategies for optimizing existing operations processes.

Supervisor-FEMA

Maximus Inc
09.2021 - 03.2022
  • Responsible for assigning day to day revalidation work items
  • Monitor employee performance for compliance to established protocol (SLA)
  • Work closely with Quality Assurance (QA) and agents are adhering to processes and procedures
  • Research and respond to any escalated clients inquiries and requests in a timely, professional fashion
  • Ensure compliance with company Wage & Hour policy, including ensuring nonexempt employees get the rest & meal breaks
  • Evaluate subordinates' job performance and recommend appropriate personnel action
  • Discuss job performance concerns with subordinates to identify causes and issues and works closely with the Human Resources department on resolving problems
  • Identify training needs and development opportunities for subordinates

Supervisor-State of Fl Unemployment

Titan Technologies
05.2020 - 09.2021
  • Supporting Florida Dept of Economic Opportunity (DEO) which Unemployment claim due to direct result of Covid 19 Pandemic
  • Responsible for Coaching agents in ensuring claimants applications are updated in order for payments to be paid
  • Responsible for Ad Hoc projects within my team to alleviate road blocks for agents
  • Supervises staff, monitors, coaches, and motivates staff to develop appropriate skills and competencies
  • Foster the attitudes, conditions, and environments that motivate staff toward achieving results
  • Remains up-to-date on any new developments to the project, communicates those changes to the staff, and ensures comprehension and compliance
  • Monitors, coaches and supports incentive programs to motivate staff towards achieving results; supports staff development of call handling skills
  • Provides leadership and direction while maintaining team morale
  • Ensures staff performance, quality, productivity and attendance standards are met; posts statistics as appropriate
  • Follows up by monitoring progress and results and taking appropriate counter measures
  • Encourages continuous improvement; involves others in planned process improvement efforts and measures; encourages/coaches individuals to follow a systematic improvement process
  • Participates as a member of the supervisory team, cooperates with peers to build consensus and share responsibilities
  • Contributes to discussions, actions, and projects and helps resolve indifference or conflicts by identifying common ground and exploring potential solutions
  • Assists human resources by interviewing prospective candidates and processing voluntary and involuntary terminations
  • Maintains attendance records, processes employee paperwork, submits payroll information as required and to support administration in an accurate and timely fashion
  • Provides meeting leadership, management, and facilitation; prepares for meetings in advance and follows up with a complete meeting record to participants
  • Supports department projects as needed including any special assignments/working hours

Claims Business Process Analyst

United Healthcare Inc
01.2017 - 04.2020
  • Responsibilities included direct customer service of non-insurance related products
  • Provided technical expertise, problem triage, instructions or general non-sales customer support
  • Utilize appropriate knowledge resources to drive resolution of applicable problems/issues (e.g., websites, CRM tools, knowledge bases, product manuals, SharePoint)
  • Gather appropriate information and perform initial problem investigation to determine scope and depth of problem
  • Assist in the installation and testing of new software and procedures relating to the applicable products, identify inefficiencies and coordinate problem resolution
  • COSMOS Claims experience
  • Responsible for CMS security access to ensure employees compliance to Part D, Optum, Medicare and Retirement in CMS.gov system
  • Provide product training, as applicable (e.g., to customers, other team members, etc.)
  • Identify recurring product problems/issues for inclusion in applicable support documentation
  • Identify and communicate needed changes to product documentation to appropriate internal resources (e.g., Product Team)
  • Ensure proper documentation of customer problems/issues (e.g., research conducted, steps required, final resolution)
  • Update process documents to reflect changes in claims business processes
  • Gather appropriate information and perform initial problem investigation to determine scope and depth of problem
  • Identify and coordinate internal resources across multiple departments to address client situations, and escalate to appropriate resources as needed
  • Identify and communicate steps/solutions to customer problems/issues, using established guidelines where available
  • Provide consulting/education on applicable claims processing platforms (e.g., COSMOS, UNET, Facets, Diamond)
  • Knowledge of RxCCR (Database Repository) and Pharmacy Benefits ID tool (PhBIT) for RX changes and benefits
  • Evaluate new software or access requirements
  • Understand application and version dependencies
  • Manage compatibility testing for any new software or software upgrades against current M&R A&G images
  • Support some training and creation of user guides for business developed tools
  • Ensure standardization of user profiles and computer images across M&R A&G
  • Support new application deployments
  • Ensure consistent use of applications and uniform data entry across all teams, products and regions
  • Facilitate regular 'Definitions' and coding meetings with A&G management
  • Assist in development of application workflows and data entry
  • Assist in development application training plans, user materials & job aides
  • Trouble-shoot systems issues and data entry for individual users
  • Act as business liaison to IT for large-scale application, network, and telephone issues affecting department productivity & compliance
  • Escalate issues as needed
  • Triage incidents and engage business and IT leadership
  • Determine level of impact and incident priority; represent Business on IT war room calls
  • Monitor incident to resolution; provide initial communication and updates throughout the life of the incident
  • Consult on workaround options and initiation business contingency plans
  • Troubleshoot day to day system issues, provide staff coaching
  • Track and report on issues that have and potential impact on compliance or upcoming audits
  • Manage department communications and workarounds during large-scale outages
  • Track issues for audit and potential impact on compliance

Service Advocate IV/Care Consultant

FLORIDA BLUE/BLUE CROSS BLUE SHIELD OF FLORIDA
03.2012 - 12.2016
  • Provide customer service by answering complex benefit questions, researching and resolving issues, inquiries and exceptions and ensuring customers understand the Company's products and processes
  • Educate members on Flexible Spending Accounts (FSA), Health Reimbursement Accounts (HRA) and Health Saving Accounts (HSA)
  • Coordinate cases for outbound calls for triage specialists, nurses/community specialists, physicians, providers and members to follow-up on inquiries, appointments, referrals and educational sessions
  • Assist members with cost comparisons based on benefit options or level of care
  • Educate the member on the use of self-service tools Inform, refer and educate the member about adjunct programs such as Health Dialog, and Care Coordination
  • Assist members with understanding their medical benefits and educate them on how to use benefits in conjunction with specific illnesses
  • 8+ years' experience in health insurance, managed patient care, physician practice, and BCBSF/Florida Blue Member
  • Understanding of disease states/health conditions and when to refer a member to a particular service or benefit such as Health Dialog
  • Understanding of provider contracting and reimbursement including provider fee schedules, participation status, and contracted lines of business
  • Successful performance on job related assessments direct (face-to-face) customer/patient service or education experience
  • Prior training experience (training peers or in and out of classroom setting)
  • Experience utilizing multiple research and processing systems (Siebel, Diamond, RBMS, or CMCA)
  • Experience working with Diamond claim adjustments
  • Experience with health and specialty products: Blue Options (including high deductible and non-standard contracts), Health Reimbursement Accounts, Healthcare Savings Accounts or Flexible Spending Accounts
  • Experience with care support programs (Care Coordination, Health Dialog, Retail Health, etc.)
  • Experience in collecting and summarizing data, identifying trends and root causes that impact customer interactions
  • Knowledge of contact center practices, processes and applications
  • Member of Siebel Enhancement Advocate Workgroup responsible for Service Desktop Enhancement which included to streamlining the various systems Customer Service advocated used to service Individual, Employee, and Employer groups
  • Responsible for assisting in creating /updating Standard Operations Procedures (SOP's) as well Desktop Procedures (DTP's) for changes to the Advocates processes
  • Assisted with creation of Visual Workplace Area where Consultants could post opportunities and issues to eliminate Waste, Errors, Abuse of the Company resources
  • Senior Service Advocate of the Care Consultant Team
  • Experience and Knowledge of understanding of Health Care Reform, Health Insurance plans, Enrollment and Billing terminology and Continuous Improvement processes
  • Competencies include Acting Decisively, Building Relationships, Communicating Effectively, Critical Thinking and Prioritizing and Organizing Work
  • Educated Prime Therapeutics (Pharmacy vendor) with PBM (Pharmacy Benefits Management) for Florida Blue

Service Advocate II

BLUE CROSS BLUE SHIELD OF FLORIDA/INCEPTURE
07.2011 - 03.2012
  • Provides customer service to plan members and providers by answering routine benefit questions, resolving issues and ensuring customers understand the Company's products and processes
  • Conduct research, resolve problems and respond to telephone and written inquiries from providers

Provider Enrollment Analyst

FIRST COAST SERVICE OPTIONS
08.2010 - 06.2011
  • Screen, validate and process sensitive information given by providers
  • Conduct research, resolve problems and respond to telephone and written inquiries from providers
  • Identify cases of suspected fraud
  • Verify information and credentials supplied by the applicant
  • Research and develop for additional information as needed to complete the enrollment application
  • Act as customer service liaison to ensure that complex issues are resolved timely
  • Interact daily verbally or in writing with physicians, attorneys and billing agents
  • Create an enrollment record in the Provider Enrollment Chain Organization System
  • Utilized ICD-- 9 and ICD 10 codes to ensure providers were in compliance with the guidelines of the Center for Medicaid and Medicare Services
  • Experience using the Multi-Carrier System (MCS) and Fiscal Intermediary Shared

Office Manager

DIAL ACCOUNTING SERVICES
01.2010 - 05.2010
  • Created and maintained customer database of existing tax customer
  • Greeted customers and set appointments for tax preparation
  • Reconciled customers billing and IRS discrepancies
  • Ordered office equipment and products
  • Follow up with IRS and tax accountants to resolve outstanding issues

Sales Associate

BELLSOUTH TELECOMMUNICATIONS INC
04.2006 - 12.2007
  • Pursued potential leads for residence customers and secured service agreements with customers with BellSouth home services
  • Reconciled customers billing and discrepancies
  • Resolved customer problems with Internet services
  • Instructed new customers on the use of their newly installed services

Project Manager / Customer Care Liaison/Consultant

ALLTEL COMMUNICATIONS INC.
08.1999 - 06.2004
  • Wrote reports for management representing services activated and revenue generated
  • Assisted Account Executives & Sales Managers
  • Pursue potential leads for commercial business and renewed service agreements with clients
  • Implemented Access Database to track market clients products and services
  • Provide training for Account Executives and Application Engineers procedures & policies for ALLTEL products and services
  • Monitored the initial installation & transition for new ALLTEL customers
  • Instructed new customers on the use of their newly installed services
  • Project management experience
  • Achievements - ALLTEL Jacksonville Campus - Maintained services for entire campus - 1999-2003 ongoing project
  • ALLTEL Stadium Conversion Project - Converted telecom services to ALLTEL network - 2000
  • Adam's Mark Hotel - Converted telecom services to ALLTEL network - 2002
  • Florida Georgia Blood Alliance - Converted telecom services to ALLTEL network - 2002

Assistant Field Sales Support Manager

GTE COMMUNICATIONS CORP.
06.1998 - 03.1999
  • Reported to Regional Sales Manager
  • Provided technical support to 6 Account Executives for the Northeast Florida Region
  • Developed technical reports, negotiated with the customer as to their location needs, proposed changes to service
  • Acquired and retained new / established accounts
  • Worked with Regional Sales Manager to develop sales strategies for the Jacksonville office Territory traveled -- Daytona, Melbourne, Orlando, and St
  • Augustine
  • Achievements -- Selected to handle a special time study project in Alpharetta, GA, to streamline the process of converting customers to GTE platform by interfacing with the Support Department Office Managers, Staff Support and various departments

Customer Service Consultant/Implementation Consultant/ Associate Project Manager

BELLSOUTH TELECOMMUNICATIONS INC.
12.1987 - 06.1998
  • Assisted Account Executives & Sales Managers
  • Maintained and coordinated services for Lucent Technologies and AT&T
  • Issued orders ad Project Manager from beginning to completion
  • Interacted with Premise Technicians, Special Services Technicians, Account Executives, Central Office Technicians, Managers and a variety of departments within BellSouth
  • Implemented and wrote complex technical orders
  • Achievements - Supervised the PBX Maintenance Revenue base for the State of Ga
  • Which included the reorganization of the database existing customers
  • Experience and gained extensive knowledge of T-1, Centrex, and PBX services
  • Assigned to BellSouth Time Study Project to study and record time, method, and speed in performance of production, repair, customer services representative, maintenance technicians, engineers for the purpose of establishing standards and improving efficiency

Education

Master of Science - Safety, Security, & Emergency Management

Eastern Kentucky University
Richmond, KY
12-2024

Graduate Certificate - Emergency Management & Disaster Resilience

Eastern Kentucky University
Richmond, KY
12-2024

Graduate Certificate - Healthcare Safety

Eastern Kentucky University
Richmond, KY
12-2024

Bachelor of Science - Public Safety Management

Florida State College At Jacksonville
Jacksonville, FL
05-2021

Associate of Arts - General Studies

Florida State College At Jacksonville
Jacksonville, FL
04-2020

Skills

  • Employee Relations
  • Customer/Employee Support
  • Workflow Management
  • Problem Analysis and Reporting
  • Investigative Research
  • Information Systems
  • Project Management
  • Problem Solving
  • Employee Engagement

Affiliations

  • JACKSONVILLE CHAMBER OF COMMERCE, 1998- Present
  • BIG SISTERS, 1994-Present
  • LEARN TO READ, 1999-Present
  • UPchieve Inc, 2022-Present

Training

  • PMP Certification Courses
  • Lean 1 Certified-Kaizen
  • Value Stream Mapping/Lean
  • Cisco Routers Training Professional Sales Skills
  • Microsoft Intro to TCP/IP
  • MS Word
  • MS Excel
  • MS Access
  • MS Power Point
  • MS Project
  • SQL
  • JAVA
  • SIEBEL
  • DIAMOND
  • Health Insurance Portability and Accountability Act (HIPAA)
  • CPW
  • ICD 10
  • Blue Relay
  • Confluence (Jira)

References

Available upon request.

Timeline

Lead Operations Analyst

Evernorth/Cigna
09.2021 - Current

Supervisor-FEMA

Maximus Inc
09.2021 - 03.2022

Supervisor-State of Fl Unemployment

Titan Technologies
05.2020 - 09.2021

Claims Business Process Analyst

United Healthcare Inc
01.2017 - 04.2020

Service Advocate IV/Care Consultant

FLORIDA BLUE/BLUE CROSS BLUE SHIELD OF FLORIDA
03.2012 - 12.2016

Service Advocate II

BLUE CROSS BLUE SHIELD OF FLORIDA/INCEPTURE
07.2011 - 03.2012

Provider Enrollment Analyst

FIRST COAST SERVICE OPTIONS
08.2010 - 06.2011

Office Manager

DIAL ACCOUNTING SERVICES
01.2010 - 05.2010

Sales Associate

BELLSOUTH TELECOMMUNICATIONS INC
04.2006 - 12.2007

Project Manager / Customer Care Liaison/Consultant

ALLTEL COMMUNICATIONS INC.
08.1999 - 06.2004

Assistant Field Sales Support Manager

GTE COMMUNICATIONS CORP.
06.1998 - 03.1999

Customer Service Consultant/Implementation Consultant/ Associate Project Manager

BELLSOUTH TELECOMMUNICATIONS INC.
12.1987 - 06.1998

Master of Science - Safety, Security, & Emergency Management

Eastern Kentucky University

Graduate Certificate - Emergency Management & Disaster Resilience

Eastern Kentucky University

Graduate Certificate - Healthcare Safety

Eastern Kentucky University

Bachelor of Science - Public Safety Management

Florida State College At Jacksonville

Associate of Arts - General Studies

Florida State College At Jacksonville

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