Debra A. Jones7777 Normandy Blvd Apt 1218

Jacksonville, Florida 32221 Mobile: 757-316-6328

Email Address: Jon7debor@aol.com

Resourceful visionary and savvy leader offering a rich mix of experiences in customer service, claims, human services, healthcare commercial insurance, Medicaid, Medicare, and sales,

Excel in the management and mentoring of others with an innovative approach that encourages and enables attainment/exceeding of imposed goals and objectives, a collaborative team approach and the desire to succeed.

PROFESSIONAL HISTORY

Utilization Management Manager 1December 2012 – April 2015Anthem BCBS –Virginia Beach VA

Managed 32 Case Specialists within the referral/preauthorization unit. Monitored work quality and performance evaluation, and issued performance improvement plans

(PIPs) when necessary. Created and prepared a variety of daily, weekly, monthly, and annual reporting’s for distribution to

management, administrators, staff, and client base Monitored call volumes, productivity metrics and staff daily adherence ratings. Served as departmental liaison to internal and external associates and customers. Assisted with contract implementations, managed program activities, monitored program compliance,

gather information, analyzed data, evaluated trends, and developed plans of action.

Eligibility SupervisorOctober 2008 to August 2011First source LLC – Portsmouth, VA

Managed 16 Medicaid/Disability Eligibility Service Reps, which included interviewing, hiring, and training new staff members.

Facilitated team meetings, hiring, scheduling, payroll, employee development and, work assignments. Promoted public relations; resolved and provided timely responses to concerns, complaints, and

conflicts Coordinated the delivery of services among various departments and services.

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Substitute TeacherSeptember 2007 to October 2008Portsmouth Public Schools – Portsmouth, VA

Designed and implemented lesson plans for children at different learning levels. Utilized a variety of lesson methods including cooperative learning, projects, discussion, games

and discovery. Participated in school events such as PTA, Open House, and team leader meetings.

Senior Outreach SpecialistJuly 1998 to April 2007

Anthem BCBS – Virginia Beach, VA Developed and fostered partnerships and awareness in the community Managed community outreach initiatives and group presentations. Participated on boards and committees to increase awareness of the health plan. Coordinated community health fairs and special events. Made home visits to new and existing Medicaid members to promote healthy lifestyles and program

compliance.

Provider/Member Service RepresentativeNovember 1996 – July 1998

Anthem BCBS Virginia Beach, VA

Handled inbound telephone inquiries Verified plan benefits Investigated and resolved service issues Coordinated member transportation.

EDUCATION

Saint Leo University 2006Saint Leo, FLBachelor of Arts (BA)Major: Sociology Minor Criminology