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706-577-9123 (cell)

334-291-8161 (home)
Personal email: Fortsde79@gmail.com

DEREK FORTSON

PROFILE Quality Control and Assurance Manager under the Enterprise Benefit Administration
division at Anthem with 9+ years of leadership and management skills involving
administration of proper benefit configuration and related work experience. Knowledge of
quality assurance activities including internal and external audits, recommending and
implementing corrective action plans, providing accurate documentation of statistical
reports and ensuring overall compliance. Demonstrated excellence in communication skills
with various levels of management state and federal regulators stakeholders and suppliers.

SKILLS & ABILITIES Extensive knowledge of internal benefit applications of WGS, CS90, FACETs, CHIPs, ACES
systems.
Rigorous collegiate training in healthcare field to include but not limited to
protocols and procedures.
Experience in business, management/supervision and computer software.
9+ years of independent and collaborative teambuilding skills,
demonstrated capability of working independently.
Accomplished in certain areas such as team leadership, recording and
presenting accurate information, troubleshooting techniques,
identification of business needs and verification of materials required for
completion of daily tasks, working in a scheduled and high-demand
production environment, and other duties as assigned.
Ability to work independently as well as work cooperatively.
Professional business acumen, poise and demeanor.

EXPERIENCE MANAGER II ANTHEM, INC.


August 2014 present
Directed leadership of business process perspective with concentration in quality
analytics and benefit configuration expertise.
Management of a diverse team of individuals to include 25 onshore associates and
100+ offshore full-time employees.
Manage training Document Management System and Quality Management system.
Planned and executed multiple tasks to ensure controlled documents were
managed per procedures.
Provided coaching to personnel on Quality systems (QS) to include document
control and training. Acted as liaison with electronic quality systems vendor(s).
Core Qualifications of management to include Corrective actions, QA requirements,
Goal setting, Program management, Internal and external audits, KPI thresholds,
Proficiency sampling and Data Management.
Responsible for directing the Quality Assurance program at an enterprise level in
all of Enterprise Benefit Administration.
BENEFIT ANALYST III/WFM AND LEAD QUALITY AUDITOR WELLPOINT, INC.
June 2010 August 2014
Extensive knowledge of WGS system and dependencies.
Responsible for reporting metrics to Senior Management and Business Partners.
Serves as POC and liaison between Sales/Account Management and EBA
Execution/Quality on various issues.
Management of external vendor relations and service level agreements (SLAs).
Inventory reconciliation and management.
Highly knowledgeable of EBA E2E workflows and processes.
Implements process improvements
Trained onshore and offshore FTEs in EBA Quality processes and procedures.
Works with Internal Audit to review and resolve audit controls.

CUSTOMER SERVICE SPECIALIST II WELLPOINT, INC.


June 2008 June 2010
Knowledgeable of CS90 and Empire New York benefits and system
processes.
Exhibited comprehensive first call customer/issue resolution.
Provided training to the entire department on various processes
(i.e. ISIS letter writing system, OBIS, etc.).
Consistently provided communications to the entire team to
enhance accuracy and eliminate knowledge gaps.
Served as direct contact for resolving issues with irate callers and
inventory reduction.
Served as a call coach and call center trainer for new trainees.

CUSTOMER SERVICE SPECIALIST III - AFLAC


June 2005 January 2008
Received inbound and provided outbound
Actively supported large and complex accounts with automated phone payments,
billing information, and issue resolution.
Composed courtesy letters upon request, provided timely follow-up on all issues,
worked on special projects for management.
Served as a call coach and call center trainer for new trainees.
Served as POC for issue research and resolution leading a team of 10-20
individuals.

EDUCATION TROY UNIVERSITY, PHENIX CITY, ALABAMA MASTER OF PUBLIC ADMINISTRATION, PUBLIC
HEALTH ADMINISTRATION
Overall G.P.A 3.5

AUBURN UNIVERSITY, AUBURN, ALABAMA BACHELOR OF SCIENCE DEGREE, BIOMEDICAL


SCIENCE AND BACHELOR OF ARTS DEGREE, SPANISH
Overall GPA 3.4

CENTRAL HIGH SCHOOL, PHENIX CITY, ALABAMA ADVANCED ACADEMIC DIPLOMA


Overall GPA 3.8, Top 10% of class.

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REFERENCES AVAILABLE UPON REQUEST

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