Del H. Allen
Columbia, SC ****3
• 20 + years of professional insurance experience
• Start-Up & Turnaround Operations
• Project Planning & Management, Federal & State Contracting
• Team Building, Mentoring & Leadership
• Change Management & Process Improvement
• Proven tactical skills, coupled with the ability to motivate and manage teams
• 20 + years of experience managing large teams in all areas of performance driven metrics.
• Lead up to 250 direct & indirect reports
• Diverse management back ground in Government/CMS, State/SCDHHS & private environments
• 20 years of experience in Medical Claims and Operations
• Skilled contract negotiator, Skilled in Marketing, product development and promotion
• Exceptional analytical, written and verbal communication, interpersonal, and leadership skills, coupled with high level of technical knowledge Senior Director Member & Provider Service & Marketing Centene / Absolute Total Care
November 2008 – November 2018
● Responsible for meeting all corporate/SCDHHS/CMS guidelines for timeliness, quality, ASA, call quality. Successfully led the team to increase service levels to 98%
● Manage interpret data models of the member and provider service areas and communicate standards with dashboards and reporting. Led in the design and development of large, multi-vendor system integration projects in Medicare/Medicaid, directly contributing to over $1 million to the company’s yearly revenue.
● Introduced key performance indicators to all employees resulting in greater focus on business results and 100% involvement
● Restructured the Member & Provider Service area to increase efficacy and effectiveness.
● Develop, implement and maintain production and quality standards for the member services staff. Successfully managing a 50% increase in call volume.
● Reviewing and creating annual Member and Provider service satisfaction surveys
● Responsible for operations of Disenrollment, Recertification & Member outreach teams
● Develop, implement and monitor policies and procedures for Member and Provider Services Departments. Monitor and create dashboards and reporting ensure compliance with Federal & State Contracting Standards
● Developed tactical plans reporting dashboards to align strategies and technologies with future needs. Effectively integrate new strategies and technologies. Plan for continuous upgrading of staff skills.
● Developed effective partnerships with all working areas, creating a better-trained workforce and harmony between the various units.
● Coordinates all aspects of the quarterly calendar and flyers from creation to production and distribution, both print and online versions. Evaluates opportunities and creates submissions, as appropriate, for new and existing free and paid advertising opportunities, including calendar entries, publications, web site links or listings.
● Design, develop, and implementation of Medicare and Medicaid health per CMS/SCDHHS protocols.
Accounts Payable Manager
Performance Food Group
April 2008 – August 2008
● Ensure timely resolution to customer issues/inquires (e.g., vendor invoice status, payment, remittance detail, etc.) received through email or phone calls and ensure that follow-up protocol for keeping customers updated is followed
● Document procedures and FAQs to assist the CSRs in responding to customer’s inquiries
● Monitor business processes related to assigned function to determine their efficiency and protective value, and assure integrity in records, information and in systems in compliance with Company policies and standards, government laws and regulations
● Review ACD, CMS, AR, GL, agent reports for teams and identify areas of opportunity
● Coordinate with other departments to resolve issues involving the customer service department
● Provide input on recommended solution for customer complaints
● Compile customer service statistics, analyze customer inquiries by type and frequencies and work with management staff to eliminate or reduce inquiries
● Develop training programs and presentations
● Develop, maintain and create IVR and CMS system and User guides for IVR, CMS system. Call Center Manager
July 2005 – April 2008
● Develops, motivates, evaluates and coaches staff on work procedures, proper call handling and teamwork delivering excellent customer service. Available to answers questions, monitor calls and give ongoing feedback to staff
● Assesses individual and team performance on a regular basis and provide candid and timely feedback regarding developmental and training needs; includes completion of monthly and annual scorecards.
● Monitors all performance measures such as daily stats and schedule adherence; allocates resources to meet volume and performance demands, with use of Crystal, SAP, IVR, ACD, and CMS systems. Develop manuals for IVR, and CMS.
● Develops and maintains strong collaborative relationships with constituents and internal business partners to maintain excellent lines of communication and share resources to meet common service center objectives.
● Attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed business goals. Builds a cohesive team that works well together.
● Acts as liaison between staff and other areas, including management, all segments, provider teams, etc., communicating workflow results, ideas, and solutions.
● Analyzes constituent data, identifies trends and issues using IVR, CMS, and ACD reports. Recognizes and acts on the need to improve the development and delivery of products and services. Clearly identifies what must be accomplished for successful completion of business objectives.
● Effectively applies and enforces Aetna HR polices and practices, i.e., FML/EML, Attendance, Code of Conduct, Disciplinary Guidelines.
Customer Care Manager
January 2004 – July 2005
● Supervised and guided UPS staff via the ACS Columbia data center Managed Client Care, NOC Operations/Call Center and Quality Control with an organization of over 60 people including all daily operations activities for 7X24 NOC.
● Assist with complex client integration projects including SAP, Crystal, GIGABYTE, SQL, DB4, 4GL, CHECKSHIPPER, IMAGEPRO, COMMPREP, equipment ordering and vendor negotiations, testing, troubleshooting, installation, and implementation of upgrades or configurations to of Kodak scanners.
● Integrated PC’s, Servers, Cisco, LAN/WAN and telecommunications, LAN Switching systems and cabling systems.
● Communicate global network status (RAPID) and provide quality documentation as well as generate any other reports requested or required by UPS and BPO management. Administering Microsoft Active Directory/Lotus User Accounts
● Establish and maintain project operating procedures as well as project priorities and schedule completion matrixes in coordination with UPS and management troubleshooting repairs and maintaining workstation hardware and software
● Interact regularly with management, UPS and incumbents to constantly improve Network Engineering services.
● Establishes and monitors operating standards and objectives to ensure accuracy and timeliness: reviews RAPID, SIR, SRB, ASD, Suspense, COD, GSD, accounts payable reports and verification activities.
● Develop and manage budget of site including salaries, equipment and all day-to-day activities.
● 10 years of experience providing customer support for Windows XP and MS Outlook in a networked environment, including experience performing computer hardware, software, break/fix, and troubleshooting.
● 15 years of experience supporting MS Office products (or other shrink-wrap software applications)
● 10 experience using a commercial trouble ticketing system (such as Remedy) and the ability to track and document actions taken.
● Develops branded marketing campaigns for new and existing initiatives as needed, including comprehensive marketing plans, logos, taglines, branded print collateral, promotional items, and original marketing copy.
Assistant Manager Collections
May 2003 – December 2003
● Maintain accurate records of accounts and make system corrections.
● Review and identify critical problems related to the closed loan file.
● Notify guarantor by phone and letter to ensure collection of delinquent accounts.
● Follow up with Loan officers for resolution of problems.
● Review mortgage information sheet for completeness.
● Print settlement statements, collection of 90+ day delinquent mortgages.
● Review of 90+ delinquent mortgages to insure all required inspections; letters, notices and calls are completed. Determine avenue of resolution of suspected problems.
● Review all loans for possible loss mitigation options and discuss these potential options with borrowers.
● Preparation of foreclosure recommendations for all accounts. Manager Provider Services
Blue Cross Blue Shield, Columbia, SC
January 2002 – January 2003
● Develop queries, SQL, COBOL to report provider data using large mainframe system structure.
● Responsible for identifying the underlying causes of provider system inquiries and initiating corrective measures to avoid future inquiries.
● Implementation of software and change/version control IVR, CMS, and ACD.
● Manage satellite computer systems for home employees.
● Management of provider information systems daily uses of SQL, DB2, DB4, and MS OS.
● Managed high-level application design and integration with existing systems.
● Developed and implemented new reporting strategies for the Managed Care area.
● Coordinated individual unit testing and support during user acceptance testing for JAVA, RACF, CICS systems.
● Designed and customized ACD and IVR systems.
● Assisted in designing and customization of company Web site and CMS systems. Developed tech manuals for ALGS, WEB, and provider tech warehouse.
● Writes, edits, and proofreads all copy for department promotions including printed materials, web pages, print advertising, catalog/handbook ads, catalog/handbook descriptions, professional and trade association articles, calendar announcements, email notices. Supervisor Provider Services
Blue Cross Blue Shield, Columbia, SC
January 1997 – December 2001
● Responsible for the direct supervision of phone counselors and workflow coordinator the
● Monitor ACD queue monitoring tools. Organize and assign workloads to ensure inbound calls, outbound contacts, and emails are handled within the appropriate service levels
● Manage and resolve complex issues in a high stress, constantly changing technical environment
● Review internal process issues, presenting viable solutions and recommendations, and assist in the development of new processes to meet the changing needs of the customers.
● Implementation of software and change/version control, IVR, CMS systems. Developed IVR manual.
● Daily use of DB2, Excel, Word, SQL, Access, PowerPoint, Windows NT. Customer Service Representative
Blue Cross Blue Shield, Columbia, SC
August 1994 – January 1997
Tax Analyst /Technical Support/ Field Services, SC Department of Revenue, Columbia, SC August 1993 - August 1994
Internal Auditor, Internal Revenue Service, Columbia, SC January 1993 - August 1993
A+, Network +, CCNA
Bachelor of Science: Degree Business Administration/Computer Information Science Morris College, Sumter, South Carolina