Ebony Clemons
Tampa
Summary
Experienced Claims/Operations Director with a strong track record in leading large-scale operations and cultivating high-performance cultures within the healthcare industry. Demonstrated ability to drive team accountability, consistently increase annual production, and significantly reduce provider complaints to enhance client satisfaction. A dedicated advocate for continuous improvement, with a strategic focus on leadership, training, and process optimization, resulting in operational excellence and elevated team performance. Committed to empowering teams, fostering talent development, and maintaining the highest standards in claims management to exceed organizational goals.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Claims Director I
Elevance
08.2018 - Current
- Direct and develop a remote team of 200 claims specialists, ensuring accurate and efficient claims processing for a dynamic Medicaid plan
- Empower team members to assume ownership of their performance, fostering a culture of accountability
- Implement strategies to reduce provider complaints by half, improving client satisfaction and operational efficiency
- Oversee the administration of 20+ million claims and $5 billion in payments annually, maintaining rigorous financial and procedural standards.
Supervisor
Cognizant Technology Solutions
11.2016 - 07.2018
- Managed team of 50 call center agents, ensuring adherence to healthcare industry standards and company policies
- Implemented performance reviews and quality assessments, initiating corrective actions to address deficiencies
- Developed innovative strategies to enhance team performance, including establishing a concierge team that successfully reduced complaint volume and streamlined Medicare CTMS operations.
Risk Manager
Hillsborough Area Regional Transit
07.2013 - 06.2016
- Oversaw general liability and workers' compensation claims, ensuring thorough investigations, evaluations, and negotiations
- Supervised comprehensive insurance program management for the authority, maintaining robust risk mitigation strategies
- Conducted regular audits on third-party administrator to ensure adherence to claim-handling protocols and standards.
Education
MBA - Healthcare Administration/Management
Saint Leo University
Saint Leo, FL2020
Skills
- Operational Efficiency Improvement
- Effective Communication Techniques
- Decision-Making Confidence
- Leadership & Team Management
- Financial & Procedural Standards Compliance
- Process Optimization
- Training Program Development
- Client Relations & Satisfaction
- Continuous Improvement
- Risk Management & Mitigation
- Claims Management Expertise
Certification
- Florida All Lines Adjusting License, #E026208
- Workers' Compensation License, Georgia, North Carolina, South Carolina, Tennessee
- Certified Florida Workers' Compensation Litigation, CWL designation
- Certified Occupational Safety Specialist, #30046150
- OSHA 10 Certified
Timeline
Claims Director I
Elevance
08.2018 - Current
Supervisor
Cognizant Technology Solutions
11.2016 - 07.2018
Risk Manager
Hillsborough Area Regional Transit
07.2013 - 06.2016
MBA - Healthcare Administration/Management
Saint Leo University
- Florida All Lines Adjusting License, #E026208
- Workers' Compensation License, Georgia, North Carolina, South Carolina, Tennessee
- Certified Florida Workers' Compensation Litigation, CWL designation
- Certified Occupational Safety Specialist, #30046150
- OSHA 10 Certified
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