Billy Pribble
Manager, Claims @Wellcove
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WORK HISTORY
Manager, Claims @Wellcove
Performs managerial and leadership functions designed to support departmental and organizational goals and objectives.•Assists in the development, direction, and maintenance of all claim eligibility and care management functions for members / policyholders.•Supervises all claim eligibility and care coordination vendor relationship staff, providing day to day oversight in performance of the LTC operational activities.•Works closely with our care coordination vendors to improve communication and processes between CHCS and each vendor. •Proposed a process to reduce assessment cost internally while creating a better customer experience for our clients and policyholders.•Assisted in the implementation of a new LTC client to include writing business requirement documents, standard operation procedures, and building the appropriate SLA reporting.•Monitors client satisfaction, trends, and outcomes. Presents eligibility and care management metrics weekly to clients.•Assists with developing and implementing departmental goals and objectives.•Maintain key performance standards through monitoring operational and financial metrics and manage workload and capacity resources, while staying within budget and unit cost parameters.•Collaborate with internal stakeholders including Finance, Compliance, Risk, and others to mitigate risk. Assisted with consumer and DOI complaints by doing full file reviews and writing response letters.
EDUCATION
Virginia Polytechnic Institute and State University
Bachelor of Science (B.S.)
SKILLS
ABOUT BILLY PRIBBLE
Claims Manager at CHCS Services Inc.
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