Patrice Downing
Louisville,Kentucky
Summary
Results-driven operations leader with 26 years of progressive experience at Humana. Extensive background in plan setup operations, vendor management, process improvement, and operational reporting. Proven ability to lead large, metric-driven teams, build strong cross-functional relationships, resolve complex issues, and drive improvements that enhance consumer and business outcomes. Six Sigma Lean certified.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Supervisor, Plan Build
Humana Inc.
Louisville, KY
01.2018 - Current
- Supervise teams responsible for both dental and medical plan setup, including Medicare, Medicaid, and Medicare Supplement (Med Supp) products, ensuring accurate and timely implementation of group benefit plans across all lines of business.
- Manage the Planload team, overseeing the resolution of aged, pended claims and the configuration/building of benefits to enable accurate and timely claims payment for all product lines.
- Oversee the creation, analysis, and maintenance of operational reports for plan setup, supporting accuracy, identifying process improvements, and informing leadership decisions.
- Serve as a liaison between internal stakeholders and external vendors, facilitating issue resolution, clarifying contract requirements, and supporting the implementation of new solutions.
- Lead vendor onboarding, contract review, and ongoing performance monitoring to ensure compliance with service-level agreements and business standards.
- Analyze complex data, research discrepancies in plan builds and vendor deliverables, and implement corrective actions to address root causes.
- Provide coaching, training, and performance feedback to associates, fostering professional growth and high team engagement.
- Collaborate with IT, Compliance, and Vendor Management teams to align plan setup and reporting processes with evolving business and regulatory requirements.
Frontline Leader, Retail Sales Operations
Humana Inc.
Louisville, KY
01.2014 - 01.2018
- Managed day-to-day operations for the Retail Sales team, supporting business growth and operational excellence.
- Delivered training and process documentation, improving associate efficiency and knowledge.
- Analyzed data trends to identify operational barriers and implemented solutions to improve performance.
Business Analyst
Humana Inc.
Louisville, KY
01.2009 - 01.2014
- Supported process improvement initiatives by conducting workflow analysis, root cause reviews, and business case development.
- Collaborated with IT and operational teams to implement system changes and resolve issues.
- Developed and maintained documentation for new and updated processes.
Analyst, Group Setup/Account Installation
Humana Inc.
Louisville, KY
01.2003 - 01.2009
- Maintained and updated commercial and government plan workflows (including Medicare/Medicaid), supporting compliance and audit requirements.
- Assisted with testing and validation of system changes to ensure accuracy and minimize issues.
- Coordinated with stakeholders for seamless implementation of plan changes.
Customer Service Representative, Billing and Enrollment
Humana Inc.
Louisville, KY
01.1998 - 01.2003
- Provided high-quality service to members by addressing benefit inquiries and resolving billing/enrollment issues.
- Consistently achieved department performance goals.
Education
B.S. - Organizational Leadership
University of Louisville
Louisville, KY01-2021
Skills
- Vendor & Stakeholder Management
- Plan Setup (Medical, Dental, Medicare, Medicaid, Med Supp)
- Plan Build and Planload System Oversight
- Aged Pend & Claims Resolution
- Process Improvement (Six Sigma)
- Operational Reporting & Data Analysis
- Cross-Functional Collaboration
- Performance Metrics & Quality Assurance
- Leadership, Training & Mentoring
Accomplishments
- Promoted through five roles over a 26-year career at Humana, reflecting consistent performance and operational leadership.
- Successfully implemented process changes that improved plan accuracy and reduced operational errors.
- Trained and mentored numerous associates, supporting their advancement within the organization.
- Recognized for cross-functional collaboration and ability to resolve complex operational and vendor challenges.
Certification
- Certificate, Human Resource Leadership, University of Louisville, 2021
- Six Sigma Lean Certification, 2017
Timeline
Supervisor, Plan Build
Humana Inc.
01.2018 - Current
Frontline Leader, Retail Sales Operations
Humana Inc.
01.2014 - 01.2018
Business Analyst
Humana Inc.
01.2009 - 01.2014
Analyst, Group Setup/Account Installation
Humana Inc.
01.2003 - 01.2009
Customer Service Representative, Billing and Enrollment
Humana Inc.
01.1998 - 01.2003
B.S. - Organizational Leadership
University of Louisville