Emmanuel Mgbojikwe
Houston,USA
Summary
A result-driven and accomplished Data Management and Customer Experience Team Lead adept in project management, process, and quality improvement. Versatile and adaptable leader with over 8 years of successful experience in leading teams and driving positive change. Recognized consistently for performance excellence and contributions to success in health insurance business operations.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Project Lead
Magellan Health
2017.10 - 2026.01
- Provided expertise as subject matter expert (SME) to enhance customer care strategies during various project initiatives and meetings.
- Managed back-office operations to ensure efficient task execution and adherence to deadlines.
- Served as subject matter expert (SME) to guide staff, clients, members, and providers in navigating health plan programs, policies, and procedures.
- Achieved successful project ramp-ups and orientation by conducting thorough interviews for customer experience associate roles in call center and data processing sectors. Identified and assessed candidate skills to align with critical job functions and company values. Enhanced recruitment processes to better meet business objectives and improve team dynamics.
- Trained team members in critical methodologies required for successful task execution.
- Oversaw compliance efforts by delivering support and resources to customer care associates, ensuring alignment with policies and customer requirements.
- Conducted comprehensive reviews of metrics to support staff compliance and implement action plans for issue resolution.
- Orchestrated strategic planning and implementation efforts for innovative initiatives.
- Developed and integrated best practices throughout the organization to optimize performance and compliance.
- Engaged with customer care quality department to drive improvements in service delivery.
- Motivated and inspired team members to achieve excellence and foster a collaborative environment.
Program Specialist
Covance
2016.04 - 2017.05
- Performed thorough insurance verifications to ensure accurate determination of patient benefits for various policy types.
- Facilitated timely prior authorization processes, improving customer satisfaction. Analyzed claim data to optimize resource allocation. Identified insurance and alternative funding sources, enhancing program effectiveness.
- Performed in-depth evaluations to identify deficiencies in service delivery, guiding program development initiatives.
- Conducted detailed analysis and evaluation of key performance indicators, leading to improved program effectiveness.
- Evaluated operational effectiveness of programs to pinpoint concerns and propose strategies for improvement.
- Achieved high levels of customer satisfaction by effectively managing inbound calls from medical providers and patients. Documented interactions in the database and addressed or escalated calls as per program specifications, enhancing overall service delivery.
- Achieved efficient handling of inbound calls, resulting in accurate data entry for insurance verification. Enhanced client experience by addressing provider outcome inquiries and copay assistance needs. Contributed to improved operational workflows in insurance support services.
- Streamlined computer systems for patient enrollment, claim denials, and payment processing to enhance operational efficiency.
Education
Bachelor of Science - Real Estate Management
Abia State University
Abia State, NigeriaMaster of Science - Health Informatics
National University
La Jolla, CA02.2019
Skills
- Data analysis and reconciliation
- Microsoft SQL server (MSSQL)
- Quality Improvement
- Process Improvement
- Analytical skills
- Regulatory Compliance
- Coaching and development - promoting continuous improvement, resulting in higher quality of work, and reduced operating expenses
- Project Management
- Performance Improvement
- Critical and Creative thinking
- Proficiency with Excel and Macros, Publisher, PowerPoint, SharePoint, Outlook, and other applications
Accomplishments
- Achieved a 99% accuracy rate while providing oversight for customer experience and claims resolution specialists processing and reviewing over 100+ mental health and substance use disorder claims daily.
- Mentored and trained new hires, leading to a 15% increase in team productivity and decreased claim review error rates.
- Resolved complex escalated mental health and substance use disorder claim disputes, improving client satisfaction scores by 30%
- Served as the Subject Matter Expert in all aspects of health plan programs in the successful implementation of TruCare care management platform.
- Received manager rating of Outstanding in 6 consecutive year-end performance evaluation as Health plan/Customer experience Team Lead
- Successfully managed User Acceptance Testing (UAT) plans and various health plan initiatives for Magellan Behavioral Health
- Developed numerous standard operating procedures (SOP) that saved hundreds of hours of patient and provider services average handle time.
Certification
- Project Management Training
- Information Technology Infrastructure Library certification (PeopleCert)
- AI in Healthcare Specialization (Stanford University)
- Improving Encounter Data for Practices training: In-progress (Integrated Healthcare Association)
Timeline
Project Lead
Magellan Health
2017.10 - 2026.01
Program Specialist
Covance
2016.04 - 2017.05
Master of Science - Health Informatics
National University
Bachelor of Science - Real Estate Management
Abia State University