Maria DeFilippis
Ballston Spa,NY
Summary
Extensive experience in the managed healthcare industry, including membership, enrollment, group implementation, and call center management. Consistently achieved success in managing relationships with internal business partners, members, providers, and clients. Strong interpersonal and conflict resolution skills enable effective navigation of complex situations and foster positive connections. Committed to delivering superior service to internal and external customers, dedicated to making a valuable impact in the healthcare field.
Overview
33
33
years of professional experience
Work History
Provider Relationship Account Manager SR Carelon Behavioral Health
Elevance
07.2022 - Current
- Increased client satisfaction by building strong relationships and addressing their needs promptly.
- Responsible for managing Provider Operations escalations, process improvement and market support to regional markets
- Oversees high impact and rework escalations related to provider data
- Coordinates research and analysis to determine root causes of issues
- Works with Provider Data Management to develop solutions
- Proactively partner with internal customers to monitor quality results and trends across Provider Operations.
Manager II, Large Group Implementation
Elevance
10.2020 - 07.2022
- Oversight of implementation, case installation and membership enrollment for Local Large group; new business and renewals
- Worked closely with Sales and Account Management to prepare for renewals and new groups to ensure timely implementation
- Helps to develop tools and best practices necessary to improve installations; Provides on-going root cause analysis; identifies opportunities for process improvement
- Ensures completion of all critical deliverables from multiple disciplines to assure timely and accurate implementation of our customers' benefit plans
- Establish and maintain collaborative relationships to drive results.
Manager II Membership, E&B Large Group Enrollment &Billing
Elevance
06.2011 - 10.2020
- Responsible for Large and Small Group membership enrollment
- Ensures that the team meets and exceeds all metrics as well as supporting quality improvement activities
- Prioritize and handle all urgent/access to care issues expeditiously
- Provides on-going root cause analysis; identifies opportunities for process improvement
- Establish and maintain collaborative relationships to drive results.
Customer Care Manager, Child Health Plus
03.2010 - 06.2011
- Oversight of call center for State Sponsored Health Plan
- Establishment of department policies and procedures
- Hire, train, coaching and performance evaluation of direct reports
- Ensure compliance with program, performance guarantees and organizational metric goals.
Manager of Claims Customer Service, Empire Plan
Value Options
05.2003 - 03.2009
- Responsible for all operational activities of a State contracted, dedicated claims customer service department for members and providers
- Manage staff members to ensure contracted performance expectations are consistently met
- Provide ongoing training and development of staff in behavioral health and substance abuse claims handling
- Implemented numerous training and process improvements to enhance efficiency.
Supervisor of Claims Customer Service
Aetna
06.1991 - 05.2003
- Supervision of customer service and claims processing staff, servicing members and providers
- Monitor results daily to ensure timely and quality service to all customers
- Involvement in various quality and process improvement workgroups.
Education
Communication Studies
The College of Saint Rose
Albany, NYSkills
- Goals and performance
- Data-driven decision-making
- Customer Service
- Teamwork and Collaboration
- Client Relations
- Issue Resolution
- Employee Mentoring
- Talent management
- Cross-Functional Collaboration
Timeline
Provider Relationship Account Manager SR Carelon Behavioral Health
Elevance
07.2022 - Current
Manager II, Large Group Implementation
Elevance
10.2020 - 07.2022
Manager II Membership, E&B Large Group Enrollment &Billing
Elevance
06.2011 - 10.2020
Customer Care Manager, Child Health Plus
03.2010 - 06.2011
Manager of Claims Customer Service, Empire Plan
Value Options
05.2003 - 03.2009
Supervisor of Claims Customer Service
Aetna
06.1991 - 05.2003
Communication Studies
The College of Saint Rose
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