Jessica T. Delva
Riverview,FL
Summary
Seasoned collaborator experienced in meeting needs, improving processes and exceeding requirements in team environments. Diligent worker with strong communication and task prioritization skills. Proficient in Microsoft Word, Excel, Outlook, PowerPoint, Publisher, Camtasia Professional and Visio. Extensive health insurance claims processing experience also.
Overview
18
18
years of professional experience
Work History
Business Analyst IV
WellCare/Centene
01.2020 - Current
- Operated as the Training team lead
- Create and maintain new hire training documentation
- Lead new trainer onboarding and progress
- Conduct provider training campaigns to educate providers and external partners on billing expectations
- Manage and identify trending and global trends and issues
- Facilitate and support operations staff in the planning, achievement, and tracking of the organizations quality initiatives
- Maintained 98+% training satisfaction rating
- Created and oversaw 3 training programs for configuration operations.
- Trained and mentored 300 new personnel hired to fulfill various roles.
- Used Camtasia to design training for configuration employees and increase company retention and productivity rates 26%.
- Facilitated virtual, in-person and blended learning sessions.
Operations Account Representative
WellCare
01.2018 - 01.2020
- Sustained solid business affiliations with substantial Florida based hospital groups
- Initiate and facilitates bi-weekly hospital meetings to improve provider satisfaction
- Lead provider training campaigns to educate providers and external partners on billing expectations
- Manage and identify trending and global trends and issues
- Review provider contracts and compare current provider configuration for update to ensure accurate provider reimbursement
- Supported customer satisfaction through regular follow-up and communication.
- Gained customer trust and confidence by demonstrating compelling, persuasive and composed professional demeanor.
- Resolved over 435 provider issues
Configuration Analyst IV
WellCare
01.2017 - 01.2018
- Update, maintain, and create payable procedure codes, price rules and fee schedules
- Facilitate monthly market meetings; work closely with provider market to resolve issues and develop solutions
- Identify and root-cause issues to ensure enterprise solutions and communicate findings as needed
- Resolved problems, improved operations and provided exceptional service.
- Demonstrated leadership skills in managing projects from concept to completion.
- Worked over 120 provider configuration requests
Configuration Specialist Sr.
WellCare
01.2016 - 01.2017
- Work closely with provider market to resolve issues and develop solutions
- Loads institutional contracts into the system through appropriate research and provider data load activities
- Performs accurate and timely provider research, verification and analysis
- Identify gaps and create documentation when necessary for load processes
- Load provider contracts
- Identified issues, analyzed information and provided solutions to problems.
- Processed over 200 provider configuration requests
- Completed 7 process improved projects
Configuration Specialist
WellCare
01.2015 - 01.2016
- Work closely with provider market to resolve issues and develop solutions
- Resolve over 315 DCRs
- Resolve provider load issues with established documented processes
- Review and work Auto Analyzer Reports
- Load provider contracts
Claims Specialist II
WellCare
01.2014 - 01.2015
- Process, adjust, and analyze professional and institutional claims
- Completed new hire audits
- Identify root-cause issues to ensure enterprise solutions and communicate findings as needed, primarily via Field Magic Tickets
- Assisted with special projects and created vendor SATs and served as project
- Achieved 99.4 % claim quality
Claims Benefit Specialist
Aetna
01.2007 - 01.2011
- Analyzed and processed medical claims
- Applied medical benefits to claims
- Processed claims for payment
- Served as a Subject Matter Expert
- Determined appropriateness of payers to protect organization and minimize risk.
- Calculated adjustments, premiums and refunds.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Verified client information by analyzing existing evidence on file.
- Checked documentation for accuracy and validity on updated systems.
Education
Bachelor's in Business Management -
St Petersburg College
Tampa, FL01.2025
Bachelor's -
University of South Florida
Tampa, FL01.2004
Associate of Arts -
Hillsborough Community College
Tampa, FL01.2003
High School -
Mt. Dora High School
Mount Dora, Florida05.2002
Skills
- Predictive modeling
- Gap analysis
- Cost-benefit analysis
- Business process improvement
- Technical writing
- Release planning
- Change management
- Strategic thinking
- Reporting and documentation
- Project presentation
- Agile methodologies
- Problem-solving
Timeline
Business Analyst IV
WellCare/Centene
01.2020 - Current
Operations Account Representative
WellCare
01.2018 - 01.2020
Configuration Analyst IV
WellCare
01.2017 - 01.2018
Configuration Specialist Sr.
WellCare
01.2016 - 01.2017
Configuration Specialist
WellCare
01.2015 - 01.2016
Claims Specialist II
WellCare
01.2014 - 01.2015
Claims Benefit Specialist
Aetna
01.2007 - 01.2011
Bachelor's in Business Management -
St Petersburg College
Bachelor's -
University of South Florida
Associate of Arts -
Hillsborough Community College
High School -
Mt. Dora High School
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