Taneisha Gibson

• Developed and maintained approximately 13 regulatory required filing such as EOCs, SOBs, and Member Handbooks for Medicare and Medicaid products.
• Researched, investigated, and resolved approximately 45 benefit inquiries per month, submitted by Member and Provider Service Representatives and Claims Adjudicators; ultimately resulting in reduced claim denials and/or discrepancies with plan documents.
• Engaged internal and external stakeholders via email and meetings, ensuring all plan document updates aligned with established timelines.
• Collaborated with team members on quality reviews and peer feedback to deliver precise, comprehensive regulatory filings.
• Led initiatives, including NCQA requirements and the Product Benefit Administration Roadshow, resulting in full compliance and improved team collaboration.

Developed and implemented training programs for staff to enhance knowledge of healthcare regulations.

• Prepared weekly review reporting to outline training class data and trends, which was ultimately used to improve the new hire training program.
• Coached approximately 20 trainees per class, through best practices, helping them build the skills needed to complete the new hire training program successfully.
• Evaluated training effectiveness through feedback and assessments, ensuring continuous improvement of content.
• Collaborated with management to identify training needs and align programs with organizational goals.

Facilitated new hire and refresher training for approximately 30 team members to include member services, outbound and performance administration teams. Managed all aspects of learning and development. Created and developed training modules and quick reference guides.

• Collaborated with other leaders to conduct training needs analysis; ultimately ensuring efficient, effective, and structured training content and courses.
• Led the employee development work group to develop employee skills and increase cross functionality.
• Created a formal new hire training program for all teams, producing consistency and performance improvement.

• Led comprehensive monthly audits based upon criteria of the Texas Department of Insurance.
• Collaborated with other leaders within cross functional teams to enhance process flow and documentation and provide performance feedback.
• Developed audit plans aligning with organizational goals and regulatory requirements.

• Managed the daily activities of employees at multiple retail store locations; including all activities that contribute to the acquisition, satisfaction, and retention of customers, resulting in revenue growth and exceptional customer experience.
• Ensured that monthly goals are met by consistently monitoring customer interactions and performance metrics as well as providing feedback and coaching.
• Oversaw store operations and departmental standards regarding courtesy, productivity, efficiency, cash management, point of sale, and customer premise equipment to achieve a smooth operation in compliance.
• Interfaced with other departments through written and verbal communications to effectively produce a world class customer experience.
• Prepared employee schedules and corrective action reports, while maintaining accurate files and records.

• Facilitated classroom training on products, services, and system utilization for approximately 15 new hire employees per class. Developed training modules, quick reference guides, and training newsletters.
• Consulted with managers and business leaders to conduct training needs analysis; ultimately ensuring efficient, effective, and structured training courses.
• Participated in pilot training initiatives as well as recommend and implement innovative solutions and enhancements to training programs.
• Provided one-on-one coaching and feedback to increase employee development and customer satisfaction.
• Monitored reports and systems for key performance indicators, time reporting, and scheduling.