Claudia Horta
Santa Ana,CA
Summary
Highly organized and self-motivated professional experienced in project management, team development and process improvement. Skilled in developing and implementing strategies to increase efficiency and performance. Passionate about driving business growth and creating positive work environment.
Overview
22
22
years of professional experience
Work History
Associate Director, Business Process – Integrated Repricing Network (IRN)
Optum
01.2022 - Current
- Identify opportunities for cross-selling new services across Medical Solutions and lay foundation for customer success
- Assisted senior leadership in managing all aspects of operations and business growth
- Develop and maintain relationships with senior level executives at assigned accounts to identify opportunities, develop alliances and ensure customer satisfaction
- Work with internal teams (Marketing, Sales, Legal, Integrations, Account Management) to assist in understanding, providing direction and coordinating activities to support new sale or customer needs
- Trained and developed department leaders and management staff for specific projects and ongoing operational needs
- Set appropriate expectations with internal teams, negotiate timelines and ensure all deadlines are achieved
- Demonstrated cost-effective revenue growth from $10M to $19M
- Strategic initiative to bring cost in house accounted revenue lift of 7% in 6 months
Sr. Manager, Client Services (Product Owner)
Change Healthcare
01.2016 - 01.2022
- Ability to deal with clients in a professional and courteous manner by developing and leveraging professional working relationships
- Support sales effort to include draft contract review, pricing proposals and review/draft contract statements of work
- Demonstrated ability manage project/program teams by leading strategies or action plans to achieve goals
- Work with technology to formulate technological solutions for operations to improve revenue
- Takes ownership for maintaining and tracking operating performance and financial impact
- Appeal rate less than 1%, best in industry
Manager, Client Services
Change Healthcare
01.2009 - 01.2016
- Developed and maintained relationships with customer and suppliers through account development
- Collaborate closely with Account Management, Sales and Finance.
- Managed and motivated employees to be productive and engaged in work
- Accomplished multiple tasks within established time-frames
- Maximized performance by monitoring daily activities and mentoring team members
- Cross-trained existing employees to maximize team agility and performance
- Managed and motivated employees to be productive and engaged in work
- Manage over 50 calls per day
- Ability to resolve appeal within 5-7 business days
Supervisor, Client Services
Change Healthcare
01.2004 - 01.2006
- Supervised team of 7 employees as well as client services department, data entry, client services research and resolution
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflow
- Administrated special projects as needed
- Handled customer complaints, resolved issues, and adjusted policies to meet changing needs
- Provided ongoing performance feedback to Manager and met productivity requirements established by Manager
- Evaluated employee performance and coached and trained to improve week areas
- Created successful work schedules for each team member to maintain deadlines and fully staff shifts
- Boosted team performance by developing customer service training materials and conducting service training
Research and Resolution Specialist
Change Healthcare
01.2004 - 01.2006
- Drove dispute resolution using effective problem-solving
- Advised parties of dispute resolution processes, policies and procedures, helping all parties involved make informed decisions
- Identify, review and obtain all additional information (claim, EOB) needed to make appropriate determination of appeal
- Prepared written suggestions or decisions regarding cases
- Proved successful working withing tight deadlines and fast-paced environment
- Strengthened communication sills through regular interactions with other
- Meet performance goals established by clients in areas of; efficiency, accuracy, quality and client satisfactions
- Appeal rate less than 1% and success appeal rate 85%.
- Organized and detailed-oriented with strong work ethic
- Adaptable and proficient in learning new concepts quickly and efficiently
Medical Claims Data Entry
Change Healthcare
01.2002 - 01.2004
- Updated and maintained patient information, documents and records
- Managed documents by organizing forms, making photocopies, filing records, preparing correspondence, and creating reports
- Created spreadsheets for more efficient record keeping
- Preserved patient confidence and protected operations by keeping information confidential
- Assisted in developing data entry processes
- Developed and implemented data entry operations
- Entered 80-100 claims hourly
Associate Director, Business Process
Optum
04.2023 - Current
- Trained and developed department leaders and management staff for specific projects and ongoing operational needs.
- Assisted senior leadership in managing all aspects of operations.
- Prioritized tasks and allocated resources appropriately to keep teams focused and productive.
- Communicated all capacity, sourcing and technology gaps with upper management.
- Engaged analytical subject matter experts outside project teams to drive troubleshooting of critical process-related deviations and enhance process improvements.
- Supported continuous process and performance improvement for manufacturing issues, robustness and compliance.
- Directed team focused on taking development projects through monetization and mass production.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Established team priorities, maintained schedules and monitored performance.
Education
Bachelor of Science - Business
University of Phoenix
Phoenix, AZ01.2020
High School Diploma -
High School Diploma
06.1995
Skills
- Expense Control
- Key Relationship Management
- Process Improvement
- Project Management
- Systems Development
- Strategic Leadership
- Relationship Building
- Team Collaboration and Leadership
- Coaching and Mentoring
- Work Planning and Prioritization
- Diversity and Inclusion Initiatives
- Decision-Making
- Critical Thinking
- Budget Management
- Resources Allocation
References
Upon Request
Languages
Spanish
Professional Working
Timeline
Associate Director, Business Process
Optum
04.2023 - Current
Associate Director, Business Process – Integrated Repricing Network (IRN)
Optum
01.2022 - Current
Sr. Manager, Client Services (Product Owner)
Change Healthcare
01.2016 - 01.2022
Manager, Client Services
Change Healthcare
01.2009 - 01.2016
Supervisor, Client Services
Change Healthcare
01.2004 - 01.2006
Research and Resolution Specialist
Change Healthcare
01.2004 - 01.2006
Medical Claims Data Entry
Change Healthcare
01.2002 - 01.2004
Bachelor of Science - Business
University of Phoenix
High School Diploma -
High School Diploma
Similar Profiles
Nowelle HoweNowelle Howe
Quality Specialist at OptumQuality Specialist at Optum
Rushik Reddy GangamRushik Reddy Gangam
Software Engineer - Remote at OptumSoftware Engineer - Remote at Optum
Arun ChoudharyArun Choudhary
Quality Analyst at OptumQuality Analyst at Optum
Adam DugginsAdam Duggins
Associate Director, Workforce Planning at OptumAssociate Director, Workforce Planning at Optum
Diana SandovalDiana Sandoval
Laboratory Technician at QEDLaboratory Technician at QED