Angie Torres
Summary
Ethical leader with several years of management experience. An intuitive visionary proficient at streamlining processes to eliminate inefficiencies. Effective at training, mentoring, and developing staff to achieve performance goals and productivity metrics.
Overview
21
21
years of professional experience
Work History
Product Operations Specialist
Excellus BlueCross BlueSheild
11.2021 - Current
- Manage product rollouts, user training, testing and internal communications.
- Document user stories and product features into detailed requirements.
- Collaborate with product owners, developers, and scrum masters to define solutions and drive progress.
- Communicate project updates to stakeholders at all levels.
- Monitor and track project progress to support timely completion.
- Work with multidisciplinary teams in new product rollout, effectively addressing inquiries and troubleshooting issues.
- Provide basic end-user troubleshooting and support.
Clinical Operations Compliance Administrator
Excellus BlueCross BlueSheild
05.2019 - 11.2021
- Developed and implemented internal auditing to verify employee compliance with established policies and procedures which resulted in consistently meeting and exceeding 98% quality metric.
- Wrote and presented reports outlining findings and recommendations from compliance audits.
- Prepared training programs to improve compliance at all levels.
- Played key role in development and launch of New Care Management Platform, providing research and development of training requirements.
- Managed practical action plans to respond to audit discoveries and compliance violations.
- Responsible for oversight of delegated entity ensuring compliance with NYS guidelines.
Call Center Manager
Excellus BlueCross BlueShield
10.2018 - 05.2019
- Developed new desk level procedures and training material to support new system platforms which resulted in the successful transition from one organization to another in less than one year.
- Coordinated day to day Call Center Operations ensuring adherence to Service Level Agreements.
- Interviewed, hired and on-boarded new call center agents.
- Monitored call quality and provided individual constructive feedback to enhance performance and address areas in need of improvement.
- Minimized workflow issues by cross-training staff on technical procedures, protocols and customer service practices.
- Cultivated positive rapport with fellow employees to boost company morale and promote employee retention.
Call Center Operations Manager
Centene Corporation
04.2017 - 09.2018
- Created policies, desk level procedures, and resource material for call center team.
- Consolidated materials and resources to a Sharepoint site which resulted in reduction of errors and improved accuracy and consistency amongst team.
- Implemented a call quality program which included coaching on service, professionalism, accuracy & documentation.
- Consistently exceeded Service Level Agreement metrics.
- Trained several key areas in the organization on new fax system.
- Supervised 18 Intake Representatives in providing excellent customer service to callers requiring assistance with prior authorization requests for medical and behavioral health services.
Supervisor, Customer Operations
Monroe Plan for Medical Care
10.2011 - 04.2017
- Consistently met and exceeded annual required metrics around various dimensions (average speed to answer (ASA), abandoned rate, and talk time) by leveraging call tracking statistics.
- Employed strategic interdepartmental processes to improve quality and service delivery, thus reducing problem resolution time by 20%.
- In conjunction with Analytics/IT teams, created performance reports that identified staff productivity, quality, and reduced errors by 25%.
- In collaboration with management team, implemented a Work at Home program to leverage a larger talent pool and to ensure business continuity.
- Improved productivity levels of the call center by implementing a 2nd level help desk.
- Spearheaded the first Team Lead leadership training, which fostered autonomy, empowerment, ownership, accountability, teamwork, and creativity and led to improved performance and productivity.
- Worked in partnership with senior leadership to successfully implement a new health plan in less than nine months.
- Successfully managed 2 system implementations by strategically leveraging resources to complete corporate and departmental project plans in a timely manner.
Team Lead, Customer Operations
Monroe Plan for Medical Care
05.2007 - 10.2011
- Lead a cross functional team responsible for reviewing, disseminating and implementing Medicaid Redesign Team (MRT) changes across the organization.
- Served as the benefit guidelines coordinator responsible for creating and maintaining written benefit guideline procedures as indicated in the Medicaid Managed Care & Child Health Plus Model Contracts.
- Resolved escalated calls and served as primary support for call center staff.
- Created a resource library enabling staff to resolve customer inquiries consistently and accurately.
- Trained call center new hires on processes and systems.
- Performed quality audits & observations on phone calls and fax work.
Claims Analyst
Monroe Plan for Medical Care
09.2005 - 04.2007
- Responsible for processing incoming provider medical claims.
- Resolved escalated customer service claim issues.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
Customer Service Representative
Monroe Plan for Medical Care
12.2002 - 08.2005
- Addressed and resolved customer complaints empathetically and professionally.
- Gathered and verified all required customer information for tracking purposes.
- Accurately documented, researched and resolved customer service issues.
- Processed incoming referral & prior authorization requests according to internal benefit guidelines.
- Resolved members and provider inquiries by utilizing internal resources.
Education
Bachelor of Science - Social Work
SUNY Brockport
Brockport, NY05.2007
High School Diploma -
East High School
Rochester, NY2000
Skills
Call Center Operations
Managing Vendor Relationships
Resolving Customer Escalations
Hiring/Developing/Leading Teams
Process Improvements
Strategic planning
Employee Relations
Affiliations
Latino Leadership Development Program Alumni 2011
Timeline
Product Operations Specialist
Excellus BlueCross BlueSheild
11.2021 - Current
Clinical Operations Compliance Administrator
Excellus BlueCross BlueSheild
05.2019 - 11.2021
Call Center Manager
Excellus BlueCross BlueShield
10.2018 - 05.2019
Call Center Operations Manager
Centene Corporation
04.2017 - 09.2018
Supervisor, Customer Operations
Monroe Plan for Medical Care
10.2011 - 04.2017
Team Lead, Customer Operations
Monroe Plan for Medical Care
05.2007 - 10.2011
Claims Analyst
Monroe Plan for Medical Care
09.2005 - 04.2007
Customer Service Representative
Monroe Plan for Medical Care
12.2002 - 08.2005
Bachelor of Science - Social Work
SUNY Brockport
High School Diploma -
East High School
Similar Profiles
Alexander KordovskiAlexander Kordovski
Account Sales Consultant - Mid Segment at Excellus BlueCross BlueShieldAccount Sales Consultant - Mid Segment at Excellus BlueCross BlueShield
Melinda GuereschiMelinda Guereschi
Scrum Master III at Excellus BlueCross BlueShieldScrum Master III at Excellus BlueCross BlueShield
Tamara AveryTamara Avery
Credentialing Specialist I at Excellus BCBSCredentialing Specialist I at Excellus BCBS