Experience

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  Genuine Parts Company

  • Atlanta, Georgia

  • Disability/FMLA Team Lead

    • Jan 2020 - Present
    • Atlanta, Georgia

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  BroadPath Healthcare Solutions

  • Arizona

  • Virtual Project Operational Supervisor

    • Oct 2018 - Apr 2019
    • Arizona

    Lead a team of customer service representatives in the management of the Affordable Care Act [ACA] in benefits, claims and eligibility for consumers. Perform quality reviews, make sure Key Performance Indicators [KPIs] are met daily. Work with third party administrators [TPAs] in the management of a high performance team.

• 

  Sedgwick

  • Orlando, Florida Area

  • FMLA / Disability Team Lead:

    • Sep 2013 - Aug 2018
    • Orlando, Florida Area

     Responsible for a team of Leave of Absence Coordinators/ Disability Specialist for a major TPA, ensuring that Federal, State and company leaves and policies are managed according to guidelines. Accountable for ensuring that LOA/ Disability Specialists meets performance guarantees, quality performance and client expectations. Responsible for the review of claim denial in order to ensure that FMLA/ Disability guidelines are followed. Works closely with the Quality department in assessing and ensuring team maintains high quality results. Maintains a team environment positive motivation in an effort to increase and maintain a high performance team.

• 

  Broward Health

  • Fort Lauderdale, Florida

  • Broward Health

    • Dec 2012 - Sep 2013
    • Fort Lauderdale, Florida

    Respond to inquiries from patients, attorneys, insurance companies on the status of accounts. Manage call center telephone trafffic and handle settlement negotiations with attorneys, patients and insurance companies.

• 

  Aetna

  • United States
  • Wellness and Fitness Services
  • 700 & Above Employee

  • Disability & FMLA Team Lead

    • Jul 2005 - Sep 2012

    Disability and Leave Claim Team Lead/ Customer Service Supervisor: Responsible for the management of the Federal Medical Leave (FMLA) benefits. Responsible for a team of Leave of Absence Coordinators, ensuring that Federal policies and procedures were managed according to FMLA guidelines. Responsible for a team of Short Term Disability Specialist. Accountable for meeting performance metrics. Responsible for the review and sign off on claim denial letters in order to ensure that ERISA guidelines were followed. Works closely with the Quality Auditor in assessing and ensuring team quality and knowledge base. Perform random audits on case managers in order to provide feedback. Monitor overall team performance on a daily basis in order to ensure that performance guarantees are met. Identify areas of opportunities for increase team performance. Work closely with management, peers and training and Development in an effort to develop processes that bring positive results in work performance and overall increase morale within the team. Works closely with clinical and vocational rehabilitation staff on integration to ensure effective and appropriate clinical support and return to work activities are performed. Responsible for responding to complaints/clarifications from the Department of Insurance (DOI) on a national level and or referring to the correct Federal/State agencies for resolution

  • Implementation Manager

    • Jul 2005 - Sep 2012

     Implementation manager for Call Center with Aetna RX Home Delivery. Responsible for the set up and hiring of Call Center representatives to begin production for new mail order facility.Provide leadership to staff by regularly assessing development opportunities and department training needs to maximize the highest levels of performance. Coach and develop staff in applying newly learned skills, techniques to achieve departmental goals. Address performance deficiencies and identify action plans. Identify improvement opportunities and provide training to enhance skill sets. Manage and direct the daily operational activities through planning, setting objectives and developing effective strategies & contingency plans to ensure goals are met. Monitor and report real time metrics to call center Director as needed. Monitor staff to make sure goals and objectives are met. Call center handled over 2500 calls per day.

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  UnitedHealth Group

  • Supervisor of Customer Service and Retention

    • Sep 1997 - Jul 2005

    Responsible for the management of the Medicare Retention program, Health Maintenance Organization (HMO), Compliance Auditor for the Personal Service Specialist and Informal Grievances. Manage a team that supports the Medicare population in understanding their benefit coverage. Responsible for the organization of community meetings with seniors to explain the changes to Medicare parts A &B on an annual basis.Follow process and make recommendations to correct claims that were not correctly process in order to remain in compliance.Managed a team of 25 call center staff on a daily basis in order to ensure that the customer’s needs are consistently met. Monitor daily metrics in order to ensure that service levels are successfully met. Monitor and report real time service levels to department manager as required. Conduct monthly coaching with individual staff members, responsible for annual performance review and conflict resolution.

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  Blue Cross Blue Shield Association

  • Blue Cross Blue Shield

    • Jul 1975 - Sep 1997

    Manage the daily operations for the Commercial department (Under/Over 300 Group Accounts), Medicare department for HMO members, Private Business Operations (PBO), Preferred Provider Organization (PPO) Federal Employee Account (FEP), National Accounts, Reciprocity Accounts and Membership & Billing Department. My direct reports included Customer Service Associates, Billing Representative and Team Leaders. Leadership as well as front line responsibilities in these different positions help me to developed skills in the area of problem solving, written and oral communication both internally and externally and strong interpersonal skills. My responsibilities also included auditing of employee cases in order to improve performance and to also make sure that we remain in compliance. Recommend improvements in areas that are of concern in an effort to maintain a high performance team. Respond to questions and, give clarification of process on a daily basis to my direct reports (25). Responsible for responding to inquiries from our customers (internal & external) telephonically or in written communication, providers, group administrators, Department of Insurance (DOI), Health Care Financing Administration (HCFA), National Council on Quality Accreditation (NCQA), Agency for Health Care Administration (AHCA) and other health care professionals. Operation skills include Coaching & Development, Hiring/termination of employees, and conduct monthly one on one with my direct reports. Complete and present annual performance reviews. Develop Policies & Procedures for the department as needed in order to remain in compliance with State and Federal guidelines.