Jacinta Dale
Jeffersonville,USA
Summary
Detail-oriented individual, equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Overview
9
9
years of professional experience
Work History
Senior Process Improvement Professional
Humana
06.2023 - Current
- Create or revise processes to improve process flow and increase associate understanding to maximize productivity and efficiency.
- Collaborate cross functionally with internal business partners to ensure current processes and procedures are accurate and remain in compliance.
- Identify automation opportunities to simplify and improve efficiency of processes.
- Manage IMS updates and enhancements to streamline IMS navigation and collection of information.
- Responsible for the effectiveness of IRT training and onboarding/offboarding management.
- Owner of the IRT monthly info session and target collaboration meetings.
- SharePoint site owner of Go/EngageIRT, responsible for maintaining accurate and effective information for internal team and external business partners.
- Owner of the IRT IMS APP Power BI dashboard responsible for enhancements and insights.
- Manage the team’s quality audit process, including QA criteria, point allotments and specifications.
SUPERVISOR
Humana
04.2022 - 06.2023
- Identify issues and/or gaps in processes and bring ideas and recommendations to leadership
- Engage in monthly 1:1 conversation to review associates' goals and provide timely, actionable feedback on performance and priorities
- Facilitate monthly Team Meetings
- Facilitate monthly IRT All Staff meetings on a rotating leader schedule
- Oversee the leadership mailbox to resolve escalations on a rotating leader schedule
- Oversee the team group chat on a rotating leader schedule
- Manages updates/new requests for the Automation Report excel sheet file for Help PPI
- Completes 4 Quality Audits per associate each month to review associate performance
- Conducts monthly Side by Sides with two associates each month
- Ensuring associates are maintaining 65+% WorkiQ productive and 90% of Provider escalations are resolved within 45 days of receipt overall
- Delegated tasks to team members according to individual strengths
- Set performance goals for staff members and helped teams meet important deadlines
- Facilitate employee recruitment and interviews
CLAIMS RESEARCH & RESOLUTION REPRESENTATIVE 4
Humana
10.2019 - 04.2022
- Daily monitoring of IMS queues and Help PPI folder to ensure open inventory is reviewed timely and all items are followed up on according to the Communication Guideline (Email/IMS); prioritization of work based on aging status and level of priority
- Proactively plan daily schedule to accommodate prioritization of work, including meetings with external providers
- Resolved time-sensitive questions or urgent request (DOI, CMS, or Critical/Executive Inquiries) within the established SLA or timeframes
- Perform in-depth research to answer complex questions within emails/general correspondence in its entirety
- Collaborate with peers, work as a team on common goals
- Actively manage inventory for SOC requests and provide timely feedback to Market partners, providers, and internal partners
- Advanced research by organizing data, generating spreadsheets, and drafting reports
CLAIMS RESEARCH & RESOLUTION REPRESENTATIVE 4
Humana
12.2017 - 10.2019
- Managed inventory within CCP, CRM, CIE, Availity, and Email
- Assigned Work/Task to associates daily
- Trained new hires to be successful within their new role
- Engaged in monthly 1:1 conversation to review associates' goals and provide timely, actionable feedback on performance and priorities
- Acknowledged and updated existing department processes
- Facilitated weekly team huddles
- Resolved escalations that arrived via phone and/or emails
- Reviewed monthly audits from quality and assurance that has been completed on associates (Quality data reviews/rebuttals/etc.)
- Utilized Microsoft Word and PowerPoint to prepare reports and presentations
CUSTOMER CONNECTION SPECIALIST
Humana
03.2016 - 12.2017
- Provided exceptional customer service to clients in fast-paced call center environment
- Manged customers effectively by identifying needs, quickly gaining trust, approaching complex situations, and resolving issues
- Created and implemented a new process for work at home associates completing Affidavits
- Developed and maintained positive relationships with customers by providing timely, accurate information and solutions to their inquiries or problems
- Followed up promptly on all unresolved cases from previous shifts
- Achieved 100% quality while maintaining 118% production
- Certified as a Subject Matter Expert
Education
BACHELOR OF ARTS - PSYCHOLOGY
Southern New Hampshire University
Manchester, NHHIGH SCHOOL DIPLOMA -
Louisville Male High School
Louisville, KYSkills
- Trustworthy
- Goal-Oriented
- Issue And Conflict Resolution
- Experience In Leadership
- Forward-Thinking
- Priority Management
- Time Management
- Critical Thinking
- Problem Resolution
- Friendly, Positive Attitude
- Teamwork and Collaboration
Timeline
Senior Process Improvement Professional
Humana
06.2023 - Current
SUPERVISOR
Humana
04.2022 - 06.2023
CLAIMS RESEARCH & RESOLUTION REPRESENTATIVE 4
Humana
10.2019 - 04.2022
CLAIMS RESEARCH & RESOLUTION REPRESENTATIVE 4
Humana
12.2017 - 10.2019
CUSTOMER CONNECTION SPECIALIST
Humana
03.2016 - 12.2017
HIGH SCHOOL DIPLOMA -
Louisville Male High School
BACHELOR OF ARTS - PSYCHOLOGY
Southern New Hampshire University
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