Management Health Insurance

IVAN DELVALLE

** ****** **. *******, ** ***** Tel. 484-***-**** Home. 860-***-**** *********.**@*****.***

LEADERSHIP PROFESSIONAL

Results-driven leader with health care management experience with the Department of Social Services and AccessHealthCT. Highly skilled with operations management, team management, and client-facing support. In-depth knowledge of call center and operations and leadership, process improvement, and team development. Possess excellent leadership, project management, analytic, and problem-solving skills. Demonstrate effective leadership based on a foundation of trust, collaboration, relationship building, and achieving positive results.

Professional Experience

Faneuil Inc. - Bristol, CT July 2016 - Present

Faneuil, Inc. – AccessHealthCT, Call Center Supervisor

●Demonstrate effective leadership skills within the newly formed AHCT Call Center for Faneuil. Took an active role in the successful implementation of the call center.

●Ability to proactively develop and maintain solid business relationships to ensure success in balancing both the organization, client, consumer, and employee needs.

●Actively participated in the development of new policies and procedures by making recommendations to ensure and manage to positive results. As the business needs dictated, identified and implemented new procedures to ensure positive results were achieved.

●Demonstrate interpersonal skills to work effectively in a team environment and maintain a professional and positive manner.

●Communicate effectively with all levels of the organization and client to ensure information is shared timely and accurately.

●Demonstrate change management aptitude and ability. Takes a proactive role in implementing change and applying new ways to develop the team by applying strong leadership qualities resulting in positive outcomes for the consumer.

●Maintain accurate call center documentation and communicate results timely

●Ensure agents are receiving the necessary training and updates to ensure compliance with legislation, policies, and new procedures.

●Ability to think strategically and identify critical success factors when developing strategy and plans for assigned area of responsibility.

Xerox Government Healthcare – East Hartford, CT Feb 2016 - July 2016

Appeals Coordinator for Access Health CT

●Demonstrated Leadership skills with DSS/AHCT Staff and hearing officers to drive continuous improvement and support of the appeals team while at the same time managing and resolving consumer complaints.

Researched verified, and evaluated case information and other factors in effort to facilitate resolution of edibility and verification documentation to be within federal and state regulatory statutes.

●Serve as an impartial facilitator to create and maintain goodwill and cooperation with the consumer and the clients.

●Prepare written hearing summaries detailing case circumstances and the actions taken which resulted in the eligibility determination decision and continued to provide follow up support to bring case to resolution.

●Identify and report error trends discovered during the Grievance Mediation process to the Quality Assurance Supervisor.

●Create, maintain, and submit required reports, as necessary.

●Effectively research, interpret, and explain federal, state, and local policies governing eligibility and participants legal rights and responsibilities.

●Work with internal business units (Premium Payment System, Eligibility, QA, DSS, and AHCT) related to error discovery, reporting, administrative hearings, and recoupments.

●Strong understanding of Medicaid, HUSKY A, C, &D, CHIP, and the ACA Market Exchange.

●Provide detail notes in data systems regarding the outcome and action of the review

●Work with client, DSS, AHCT and other organizations to resolve inquiries in a timely, accurate, and professional manner.

Xerox Government Healthcare – East Hartford, CT May 2013-Feb 2016

Customer Care Representative

●Managed high volumes of workloads and calls

●Obtained and verified the clients’ information

●Provided clients with clear and accurate information about health insurance programs

●Assisted clients with applying for health insurance coverage for State of Connecticut Medicaid, CHIP/HUSKY B, HUSKY A, HUSKY C, HUSKY D programs

●Utilized the DSS Eligibility Management System (EMS) and the AHCT Consumer and Worker Portals to resolve customer inquiries and troubleshoot any issues they may have experienced.

Education

Aviation High School

Long Island City, NY

College of Aeronautics

Flushing NY

Military Services

US NAVY

References available upon request

Contact this candidate