Angela Valencia
Irvine,CA
Summary
Dynamic leader with a proven track record at SCAN Health Plan, adept in staff management and process improvement. Excelled in complex problem-solving and analytical thinking, significantly enhancing customer satisfaction and operational efficiency. Skilled in audit reporting and employee motivation, consistently achieving corporate goals.
Overview
10
10
years of professional experience
Work History
Supervisor, Grievance and Appeals
SCAN Health Plan
10.2021 - Current
- Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
- Monitored workflow to improve employee time management and increase productivity.
- Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
- Created processes to assist with work flow of the department.
- Updated Policy and Procedures to align with current business processes using Policy Tech.
- Worked with Internal Audit to ensure that we are following CMS/DHS guidance in current workflows.
- Conduct monthly audits for internal team to ensure process is working and to ensure that the team is meeting internal and corporate goals.
- Aid with 5-star review and ensuring that the department is aligned with corporate standards for Part C appeals.
- Created reports for performance and production monitoring of staff.
- Worked with business analysis to ensure proper procedures are being followed to meet CMS guidance.
- Evaluated CTMs and trends to aid in the reduction of complaints and increase member satisfaction.
- Created an audit tool to aid the audit team with the evaluation of month-end grievance cases and scoring of each individual employee.
Supervisor, Pharmacy Administration
SCAN Health Plan
02.2018 - 10.2021
- Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
- Monitored workflow to improve employee time management and increase productivity.
- Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
- Maintained compliance with company policies, objectives, and communication goals.
- Evaluated employee performance and coached and trained to improve weak areas.
- Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.
- Mentored newly hired employees on operating equipment and safety and developed training manual to use for reference.
- Achieved results by working with staff to meet established targets.
- Enhanced communication within the team by holding regular meetings and encouraging open dialogue among all members.
- Collaborated with other departments to achieve organizational goals, fostering teamwork across various functions.
Specialist, Grievance and Appeals
L.A Care Health Plan
07.2014 - 02.2018
- Followed all company policies and procedures to deliver quality work.
- Developed strong client relationships through consistent communication and attentive service.
- Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
- Interpreted clients' needs and introduced services to fit specific requirements.
- Listened and responded to customer requests and forwarded necessary information to superiors.
- Oversaw daily operations of a busy office environment, ensuring tasks were completed efficiently and accurately.
- Built and managed relationships with key clients and partners to drive growth.
- Collaborated with cross-functional teams to achieve member satisfaction and grievance resolution.
Senior Specialist, Grievance and Appeals
L.A Care Health Plan
07.2014 - 02.2018
- Drove change through quality-oriented strategies to help operations accomplish ambitious short- and long-term goals.
- Identified areas in need of critical improvement and implemented strategies to achieve targets.
- Managed complex projects from inception to completion, ensuring timely delivery and member satisfaction.
- Supported department leadership in implementing new policies, procedures and controls.
- Established strong working relationships with vendors/medical groups through exceptional customer service and proactive communication efforts.
- Introduced innovative solutions to address critical business challenges, driving significant improvements in performance metrics.
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Assisted with internal audits and external audit readiness.
- Participated in program and internal audits to drive audit readiness.
- Communicated with Auditors to ensure a clear understanding of business processes.
- Worked with leadership to ensure timely review/closure of cases within the department.
- Handled high-touch cases such as DMHC, State Hearings as well as other escalated cases.
- Worked with Care Navigators to ensure proper and thorough responses were reported to regulators.
- Assisted internal department audit team with process improvement to ensure the best audit outcomes.
- Coordinated, managed and implemented auditing projects and prepared for evaluation such as putting together packets.
- Worked with Customer Service Solution call center to ensure that member complaints were addressed properly.
Education
Pharmacy Technician License - Pharmacy Technology
American Career College
Anaheim, CAParalegal Studies - Health Care
Irvine Valley College
Irvine, CA05.2026
Skills
- Training and mentoring
- Goal-Oriented
- Staff Management
- Employee Motivation
- Complex Problem-Solving
- Processes and procedures
- Process Improvement
- Analytical Thinking
- Audit reporting
- Data Analysis
- Program Evaluation
Timeline
Supervisor, Grievance and Appeals
SCAN Health Plan
10.2021 - Current
Supervisor, Pharmacy Administration
SCAN Health Plan
02.2018 - 10.2021
Specialist, Grievance and Appeals
L.A Care Health Plan
07.2014 - 02.2018
Senior Specialist, Grievance and Appeals
L.A Care Health Plan
07.2014 - 02.2018
Pharmacy Technician License - Pharmacy Technology
American Career College
Paralegal Studies - Health Care
Irvine Valley College