Vanessa Rutledge is a proactive manager with over 15 years of experience in healthcare management, customer service, claims processing, and project management. She currently works as a Manager II for Health Services Programs at Anthem Inc., where she oversees a team of 50 agents and ensures department metrics are met. Prior to this, she held supervisory roles at Centene Corporation/Peach State Health Plan and WellPoint/Blue Choice and Blue Shield of Georgia, where she managed call center operations and provider/member services. Rutledge has diverse skills in leadership, relationship building, problem solving, coding, reporting, process improvement, and compliance.

1. VANESSA ANN RUTLEDGE
Covington, GA 30016
vanessarutledge22@yahoo.com 770-508-4222 www.linkedin.com/in/vanessa-rutledge-
ab2a9151
PROACTIVE MANAGER
Effective Leader in Process Improvement, Provider Relations, Customer
Service, Claims, Medical Benefits and Project Management
Management professional with a proven track record for engaging existing staff and
consistently recruiting / training new staff to deliver results against business metrics.
Excel at setting goals, writing policies / procedures, and coaching for ever-improving
results in high-volume, dynamic, customer-facing areas. I’m Able to guide staff through
complex situations and effectively implement change. Strategically identifying
opportunities for improvement, operations, and developing winning solutions.
Diversified experience spans client services, training and project management.
Engaging facilitator with strong client relationship management skills. Manage
resources, timeframes and multiple priorities and create strategic partnerships to
achieve ambitious goals.
CORE COMPETENCIES
• Leadership  Customer Operations
• Relationship Building
• Strong problem solving
/analytical skills
• CPT/HCPC Coding
• Ad Hoc Reporting
• Quality Control
 Organizational
 EffectiveTime
Management
 Diverse expertise in
multi-tasking and
prioritizing projects
• Process Improvement
• Compliance Reporting
 Project Management
 Claims Resolution
PROFESSIONAL EXPERIENCE
ANTHEM INC., Atlanta, Ga. 2014 – Present
Manager II, Health Services Programs
Manage team of 50 non-clinical and clinical agents in high-volume call center,
responding to inbound and outbound disease management calls regarding Medicaid
issues. Ensure department meets all Key Performance Indicators (KPI’s), including

2. Service Levels, Handle Time, ACW, Talk Time, and Not Ready Targets, driving
operations financial results. Senior Service Associate
• Ensure operational and regulatory excellence and efficiency of member call center,
through achieving KPI standards and all regulatory requirements while maintaining
high quality of service.
• Monitor team activities’, including attendance, professional behavior and
development ensuring staff meets performance standards and operating effectively
and efficiently.
· Prepare and perform Employee Yearly Appraisals and Performance Management by
goal setting, measuring and communicating to direct reports ensuring direct
feedback to guide associates to clearly understand what’s expected and know how
well their doing.
CENTENE CORPORATION / PEACH STATE HEALTH PLAN, Atlanta, GA 2005 –
2014
Supervisor, Medicare, Medicaid, Provider, Member Solutions
Maintained operational and regulatory excellence and efficiency of multi-functional unit
member and provider call center including, achieving KPI standards, ensuring all
regulatory requirement met and quality of service delivered. Hired, motivated, coached,
counseled, and supervised daily functions of call center staff.
• Planned and managed day-to-day operations of Provider, Member Solutions call
center, ensuring department KPI’s including Service Levels, Handle Time, ACW, Talk
Time, and Not Ready Targets met.
• Led, planned and analyzed business procedures regarding Medicaid and Medicare
billing workflows, ensuring compliance and regulatory items met.
• Developed and implemented provider associate training, delivering exceptional
support to providers and ensuring credentialing, current provider data, contractual
compliance, claims resolution, CPT/HCPC coding and procedural training needs are
met.
• Partnered with providers to resolve escalated claim issues and concerns. Initiating
claim projects for final claim payments.
• Managed implementation and integration projects, ensuring deliverables are met.
• Participated in cross functional team meetings and problem resolution activities
resulting in final payments and decreased queue backlog and reduced call center
volumes.
• Created, documented and implemented departmental policy, procedures and
processes, including Quality Auditing, call flows, claims appeals while uploading to
shared database, resulting in establishing and maintaining collaborative cross-
functional relationships.

3. • Ensured compliance with departmental policies and procedures, through performing
audits monitoring efficiency and compliance with policies.
• Monitored team activities, ensuring staff performance standards met and operating
effectively and efficiently,
• Prepare and perform Employee Yearly Appraisals/Performance Management: goal
setting, measuring and communicating to direct reports
WELLPOINT / BLUE CHOICE AND BLUE SHIELD OF GEORGIA, Atlanta, Ga.
2000 – 2005
CCAIII / Senior Representative
Managed escalated claim review for customer service department. Processed medical,
dental and vision claims for managed and non-managed care plans with exceptional
quality.
• Trained new Customer Service Representatives of department guidelines on how to
respond to members and providers inquiries ensuring fully functional Customer
Service Representative.
• Drafted departmental letters for members and providers as requested for validation
of eligibility and claim payment resolution.
• Fully proficient in all aspects of customer service, claims issue resolution, research
and analysis, and advocating on behalf of customers through whole case methods.
ADDITIONAL EXPERIENCE
Senior Service Associate
UNITED HEALTHCARE, Atlanta, Ga.
Member Care Specialist
HARRINGTON BENEFITS, Atlanta, Ga.
Customer Service Representative
PRINCIPLE HEALTHCARE OF FLORIDA, Miami, Fl.
Supervisor
JOHN ALDEN LIFE INSURANCE COMPANY, Miami, FL.
Medicare Specialist
INSTITUTE FOR LAB MEDICINE, Miami, FL.
Billing Specialist
SMITHKLINE BEECHAM LABORATORY, Atlanta, GA
EDUCATION

4. Business Marketing, American Intercontinental University, Atlanta, GA
Business Administration, Ashford University, Atlanta, GA
MANAGEMENT TRAINING
Centene Leadership Institute (CLI)
Centene Academy for Leadership Excellence (CLA)
TECHNICAL SKILLS
Microsoft Office, MS Excel, MS Word and MS PowerPoint, Avaya, Impact Pro, IVR, Auto
Dialer, Call Monitoring Systems ELIZA, CMS, Amisys, Macess, QCARE, ImPAC 360
Georgia Medicaid, Medicare, Medicare Advantage, Manage Care, Commercial. HMO,
CMO, PPO.
MEMBERSHIP
Toastmasters International