Supervisor, Operations - Centene Corporation - Little Rock, AR
(2024-11)
- Lead a team responsible for member and provider issue resolution, including grievances, appeals, regulatory complaints, and escalations.
- Ensure compliance with federal, state, and organizational requirements while maintaining quality and productivity standards.
- Provide daily coaching, guidance, and performance oversight to team members.
- Monitor operational metrics and implement process improvements to enhance efficiency and service quality.
- Partner with leadership and cross-functional departments to resolve complex issues and support organizational goals.
- Serve as an escalation point for high-priority member and provider concerns.
- Support employee development through training, mentoring, and performance management.
Lead Member Relationship Liaison - Centene Corporation - Little Rock, AR
(2017-11 - 2024-11)
- Served as subject matter expert for Issue Resolution processes and workflows.
- Researched and processed member and provider grievances in compliance with federal, state, and organizational regulations.
- Reviewed cases for potential quality and access concerns.
- Provided guidance and support to team members regarding complaint resolution.
- Assisted with onboarding and training of new employees.
- Supported leadership with operational priorities and case management activities.
Lead Claims Examiner - Transamerica - Little Rock, AR
(2008-10 - 2017-11)
- Investigated complex and potentially fraudulent claims.
- Reviewed and approved claim payments and denials.
- Evaluated departmental reports and performance metrics.
- Trained new claims employees and supported departmental development initiatives.
- Participated in special projects and process improvement efforts.
- Coordinated departmental meetings and maintained reporting requirements.
Provider Rapid Resolution Expert - UnitedHealthcare - Little Rock, AR
(2008-01 - 2008-10)
- Provided customer service support to providers and members.
- Researched claims and policy inquiries.
- Prepared and maintained documentation related to provider and policy requests.
- Assisted with issue resolution and record management activities.
