Jennifer Guerrero
Kyle,TX
Summary
Dynamic Service Management Lead at Accenture Operations with expertise in program management and healthcare compliance. Proven track record in process improvement and stakeholder engagement, driving efficiency and achieving 100% SLA. Adept at data analysis and team leadership, fostering strong relationships to enhance operational success.
Overview
22
22
years of professional experience
Work History
Service Management Lead
Accenture Operations/Centene Corporation
07.2022 - 12.2025
- Lead the delivery of programs, projects or managed services.
- Coordinate projects through contract management and shared service coordination.
- Quickly learned new client-administered projects and became the subject matter expert (SME), providing ongoing guidance and support to frontline agents.
- Develop and maintain relationships with key stakeholders and sponsors to ensure high levels of commitment and enable strategic agenda.
- Analyzed existing processes to identify bottlenecks and improvement areas, providing actionable insights for leadership.
- Demonstrate expert knowledge of processes and related systems to effectively perform responsibilities.
- Compiled and reviewed daily client reports, ensuring data integrity and timely delivery to meet deadlines.
- Supported the QA Audit manager in conducting daily team audits.
- Attends meetings with the QA Teams, internal/external, to review trends and to develop corrective actions plans.
- Identify and assist with development of support materials for team use, e.g., training manuals, role aids, and views in databases.
- May perform data entry or other client related tasks in various systems, as required.
- Manage numerous, complex projects requiring high level capabilities with minimal supervision.
- Conducted weekly outbound OIC calls to third-party entities to verify coverage details and obtain documentation, ensuring accurate and timely updates to member records in Medicaid eligibility and claims systems.
- National Third-Party Liability (TPL) Department
TPL Program Lead for Claims Recoveries
Accenture Operations/MassHealth TPL
10.2020 - 07.2022
- Oversees daily claim recoveries to ensure delivery of SLAs for the State of Massachusetts.
- Facilitated communication with EOHHS on health insurance investigations and claims recovery, ensuring alignment on premium assistance processes.
- Interpret day-to-day business objectives and prepare/execute operational practices/work programs.
- Ensure proper execution of processes by team i.e. Coordination of daily work queues and inventory.
- Worked closely with the clearing house to determine errors in billing.
- Facilitated onboarding for new employees, equipping them with essential skills and knowledge for their roles.
- Balanced workloads to distribute responsibilities evenly and identified development opportunities.
- Managed workloads for balanced distribution of responsibilities, coordinating with supervisor and workforce planner to identify development opportunities.
- Directed daily operations of the group, overseeing work assignments, shift information flow, and strategies for workload, equipment, staffing, and scheduling.
- May perform and/or ensure completion of quality review check on outgoing work (e.g., proof data entry, correspondence, and other tasks) within immediate team to ensure quality, accuracy, and consistency.
- Third-Party Liability (TPL) Department
TPL Recovery Specialist
Accenture Operations/MassHealth TPL Aged and Denied
02.2019 - 10.2020
- Research and Process TPL Medicaid payments for the state of Massachusetts.
- Conducted daily outbound calls to providers and third-party entities to gather refund details and supporting documentation, ensuring accurate processing of refund checks back to Medicaid program in compliance with overpayment and third-party liability recovery requirements.
- Fulfilled productivity goals to ensure timely processing of payments, contributing to overall operational efficiency.
- Investigated and resolved payment discrepancies, facilitating accurate financial reporting.
- Reconcile payments by utilizing supporting detail based on established guidelines.
- Ensures the contractual obligations are met with Massachusetts EOHHS.
- Analyzed existing processes to identify bottlenecks and recommend improvements to leadership.
- Third Party Liability (TPL) Department
Recovery Engagement, Postings Lead
Accenture Operations/Texas Medicaid and Healthcare Partnership
Austin, USA
02.2004 - 10.2020
- Oversaw report generation and analysis for Recovery department, ensuring data-driven decision-making.
- Consults with and serves as a subject matter expert to various management, other departments, and other internal and external customers, within the Medicaid field.
- Responds to escalated inquiries within specified due dates.
- Recommended process improvements to management, enhancing operational efficiency and effectiveness.
- Develop team goals and implement strategies to ensure that they are reached.
- Ensures our contractual obligations are met with HHSC.
- Communicate weekly with OIG, OAG, attorneys and HHSC /Oversight offices regarding outstanding provider cases.
- Analyzed and processed provider, insurance companies, state warrants, and collection checks.
- Collect and tabulate workload statistics when requested – reconciling Medicaid client’s payments at HHSC request.
- Create and monitor accounts receivable for the Recovery, Collections and Claims department.
- Delivered subject matter expertise for core workflows, streamlining training and onboarding processes for new agents.
- Quality and approve payouts submitted back to the providers and insurance companies.
- Provide leadership and manage the department daily; make quick decisions; solve problems; create daily team goals.
- Assist Customer Service Department with provider and Insurance escalation requests- customer inquiries, complaints and billing questions.
- Observe professional standards of conduct, including attendance, professional behavior and dress code.
- Provide comprehensive and accurate memo responses, including proposed solutions to any deficiencies/discrepancies identified, on all HHSC State Action Request (SAR) memos within 30 days of receipt or by the date specified in the SAR memo.
- Contributor to the Provider Enrollment, Account Receivable and Claims Department SARs.
- Establish 100% SLA for the department.
- Managed and monitor provider overpayment agreement cases, provider vendor holds, Medicaid Provider Transportation child support holds and Voluntary Repayment Program (Visa) payments.
- Third Party Liability/REaP Department
Skills
- Program management
- Healthcare compliance
- Claims processing
- Data analysis
- Contract management
- Stakeholder engagement
- Process improvement
- Customer relationship management
- Team leadership
- Problem solving
- Effective communication
- Task prioritization
- Attention to detail
- Supervision and leadership
- Analytical thinking
- MS office
- Analytical and critical thinking
- Multitasking Abilities
Timeline
Service Management Lead
Accenture Operations/Centene Corporation
07.2022 - 12.2025
TPL Program Lead for Claims Recoveries
Accenture Operations/MassHealth TPL
10.2020 - 07.2022
TPL Recovery Specialist
Accenture Operations/MassHealth TPL Aged and Denied
02.2019 - 10.2020
Recovery Engagement, Postings Lead
Accenture Operations/Texas Medicaid and Healthcare Partnership
02.2004 - 10.2020