Cox Donna

Experience

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  Florida Blue

  Dec 1999 - Jan 2018

  Contact Service Manager, (November 2013-Present)• Responsible for communicating, planning, motivating and providing leadership to a multi-functional team that provides superior service to our members and providers. • Responsible for tactical or strategic execution and implementation of strategic initiatives.• Provides direction and effective performance management.• Insure effective quality control procedures are in place and followed.• Prepares communications and educates staff on standardized procedures.• Plan, organize, direct and control all activities of assigned department(s) and team.• Provides insight to formulating budget, plans, cost management and resources.• Responsible for hiring decisions.• Recruit select and retain talented employees.• Oversee project development and delivery.• Influence, interaction and decision-making spans between division and unit level. • Contributes to the development of business strategy in order to develop and implement plans and business process in support of goals.• Collaborates through complexities associated with coordination across multiple areas, conflicting efforts and limited resources.• Respond promptly to critical issues from customers.• Research provider issues and resolved escalated provider challenges.• Manage team production, work flows, schedules and reports.• Responsible for performance measurements and assist with the identification and implementation of process improvements.• Coached supported and developed Service representatives and Senior Representatives (SME -Subject Matter Experts). • Motivate, and develop staff to achieve target results and high performing team. Assess performance of projects and staff and ensure timely and effective implementation of initiatives. Show less Contact Organization Communications Analyst, (May 2012 –October 2013)ICD10 Business Analyst, (December 2011-May 2012)• Establish and maintain standardized internal communication.• Responsible for inventory management including tracking, trending, reporting, feedback, education, and job clarifications. • Manage levels of performance and assist with employees’ professional growth.• Coordinates communications across all lines of business over six separate business units.• Developed communications when multiple businesses are impacted. • Approve, view and disseminated global guidelines and standard operating procedures.• Development of educational programs for Florida Blue's Contact Areas.• Dedicate testing analyst on Diamond for ICD10 diagnosis codes and mapping of associated procedure codes.• Responsible for auditing all contact areas. Show less Customer service advocate V- Senior, June 2007-December 2011Provider Liaison Representative, April 2005 –May 2007BlueCard Provider Contact Representative, July 2004-March 2005Operation Customer Service Representative, December 1999-2004• Identifies, develops, recommends, and implements processes.• Supports assigned components of one or more projects.• Serves as subject matter expert on projects or workgroups. • Identifies gaps and provides education and training on changes, updates, and/or improvements of procedures to the frontline staff.• Serves as primary resource for senior leadership for the immediate handling of complaints about service, benefits, contract limitations, etc. to achieve rapid and mutually acceptable resolutions.• Facilitates resolutions the highest level of escalated or sensitive customer complaints.• Handle outbound and inbound calls from BCBS providers, agents and members to effectively educate on member’s benefits and claims processing for the following products: BlueOptions, BlueChoice, BlueCare, Traditional health insurance products, Federal Employee Program (FEP), State (SAO), and Medicare/Over 65.• Processed appeals for Veteran Administration and Shands hospital facilities.• Research escalated issue and provides root cause and resolution to operations management.• Provide one-on-one coaching to providers to ensure processes are being followed regarding billing procedures. • Diamond claims entry and adjustments.• Handle inbound calls from BCBSF members and providers to effectively educate on benefits and claim status. (legacy claims entry, reopens, and adjustments) Show less

  • Contact Service Manager

    Nov 2013 - Jan 2018

  • Business Analyst

    Dec 2011 - Nov 2013

  • Member Provider Liasion

    Dec 1999 - Dec 2011
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  Centene Corporation

  Jan 2018 - now

  Project Analyst II at Centene
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  Wellcare Medicare

  Jan 2018 - Jan 2018

  Project Analyst