Angelica Santillan
Whittier,CA
Summary
Business consultant with proven expertise in driving 50% membership growth at Aetna Health Plan through strategic initiatives. Skilled in health plan administration and provider relations, enhancing team performance and member satisfaction. Demonstrated success in process improvement and business development within the healthcare sector.
Overview
23
23
years of professional experience
Work History
Sr Manager, Health Plan Business Consultant
Aetna Health Plan
Santa Ana, CA
07.2020 - Current
- Support the Medicare Operations team across departments and external partners to enhance member satisfaction.
- Develop business plans that mitigate membership lapse, achieving a 90% success rate and over 50% membership growth in four and a half years.
- Collaborate with stakeholders to identify new opportunities, and establish successful partnerships.
- Streamline retention initiatives across multiple domains to foster a culture of retention, and improve business performance.
- Lead cross-functional teams to meet project milestones and deliver high-quality outcomes.
- Identify risk areas, implement workflows to reduce member abrasion, and monitor escalation processes for effective resolution.
- Design go-to-market strategies in partnership with sales and marketing teams.
- Identify product gaps and generate innovative ideas to expand market share, improve customer experience, and drive growth.
- Create customized training materials and dynamic presentations to enhance staff performance and audience engagement.
- Manage multiple projects simultaneously, ensuring strict adherence to deadlines and quality standards.
Provider Network Representative
PIH Health Physicians
Whittier, CA
07.2016 - 06.2020
- Delivered training and development for physicians and office staff on compensation packages and resources.
- Maintained communication with network providers, updating policies, procedures, and events.
- Achieved 15% membership growth by implementing strategic marketing initiatives to recruit physicians.
- Conducted audits of contractual agreements, ensuring documentation accuracy.
- Provided guidance on contract terms to both existing and new providers.
- Trained new personnel on company operations, policies, and available services.
- Performed thorough audits of network configurations, identifying improvement areas and recommending actions to close gaps.
- Maintained strong working relationships with health plan representatives.
Network Development Representative
St. Vincent IPA
Cerritos, CA
11.2015 - 07.2016
- Identified prospective provider partners, promoting organization compensation packages and services to recruit additional PCPs and specialists into the network
- Partnered with brokers and area health plans to coordinate targeted internal and external marketing events, enabling the achievement of network growth and development initiatives
- Consulted with physician offices, delivering provider support by developing a tool that enabled physicians to track progress within the medical group.
Special Investigation Unit Investigator
Care1st Health Plan
01.2013 - 12.2015
Physician Advocate
United Healthcare
01.2013 - 12.2013
Senior Claims Examiner
Anthem BlueCross
01.2008 - 12.2012
Senior Customer Serv Rep
BlueCross of California
01.2003 - 12.2008
Education
Master of Health Administration - Public Health
University of La Verne
La Verne, CALa Verne, CA
Bachelor of Arts - Sociology
California State Polytechnic
Pomona, CAPomona, CA
Associates of Arts - Administration of Justice
East Los Angeles College
Monterey Park, CAMonterey Park, CA
Certified Medical Assistant -
North-West College
West Covina, CAWest Covina, CA
Skills
- Health plan administration
- Health plan specialist
- Practice operations management
- Membership retention
- Customer relationship management
- Product and service knowledge
- Provider relations management
- Process improvement strategies
- Business development initiatives
- Network development
- Insurance industry practices
- Healthcare regulations compliance
- Cross-functional team leadership
- Verbal and written communication
- Instructional methods design
- Learning strategy development
- Program design and implementation
Timeline
Sr Manager, Health Plan Business Consultant
Aetna Health Plan
07.2020 - Current
Provider Network Representative
PIH Health Physicians
07.2016 - 06.2020
Network Development Representative
St. Vincent IPA
11.2015 - 07.2016
Special Investigation Unit Investigator
Care1st Health Plan
01.2013 - 12.2015
Physician Advocate
United Healthcare
01.2013 - 12.2013
Senior Claims Examiner
Anthem BlueCross
01.2008 - 12.2012
Senior Customer Serv Rep
BlueCross of California
01.2003 - 12.2008
Master of Health Administration - Public Health
University of La Verne
Bachelor of Arts - Sociology
California State Polytechnic
Associates of Arts - Administration of Justice
East Los Angeles College
Certified Medical Assistant -
North-West College
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