Jesika Somora
Saint Paul,MN
Summary
Healthcare professional with 10+ years of experience across diverse roles. Currently focused on claims resolution, provider relations, and project management. Demonstrated success in handling high-priority escalations and developing robust provider partnerships. Expertise in driving cross-functional initiatives and optimizing processes for operational excellence. Known for strong leadership and collaborative problem-solving skills within intricate healthcare systems.
Overview
9
9
years of professional experience
Work History
Provider Relations Advocate
UCare Minnesota
Minneapolis, Minnesota
08.2023 - Current
- Lead the investigation and resolution of complex, systemic claims processing issues by determining the root cause.
- Foster and sustain strong, trust-centered partnerships with high-priority clients by implementing regular communication, resolving conflicts, and conducting monthly meetings.
- Influence process improvements by identifying trends, escalating recurring issues, and contributing to long-term operational solutions.
- Oversee and resolve highly escalated complaints while ensuring regulatory compliance and timely resolutions.
- Executed proactive outreach to providers with prior regulatory concerns, supporting compliance alignment, and risk mitigation.
Customer Service Representative Team Lead
UCare Minnesota
Minneapolis, Minnesota
12.2021 - 08.2023
- Resolved escalated customer complaints promptly to enhance service quality.
- Guided Customer Service Representatives daily, fostering a collaborative environment.
- Identified and recommended process improvements to elevate customer service standards.
- Acted as primary contact for internal and external inquiries regarding EIDBI services.
- Coordinated with various departments to ensure swift resolution of complex inquiries.
Customer Service Representative
UCare Minnesota
Minneapolis, Minnesota
11.2020 - 12.2021
- Assisted providers with inquiries regarding health plans, benefits, claims, and authorizations.
- Delivered exceptional customer service to achieve high levels of satisfaction.
- Resolved issues swiftly through effective solutions and thorough communication.
- Maintained professionalism under pressure, effectively diffusing tense situations.
Clinic Assistant
Twin Cities Spine Center
Minneapolis, Minnesota
03.2018 - 11.2020
- Assisted medical team during patient examinations and treatments to ensure efficiency.
- Provided timely, accurate responses to patient inquires, contributing to high-quality patient support and service
- Consistently stocked medical supplies and prepared patient charts before appointments.
- Explained treatment procedures and communicated physicians' instructions clearly.
- Coordinated arrangements for prescribed injections, specialist referrals, and diagnostic procedures.
Nursing Station Technician
Fairview Health Services
Minneapolis, Minnesota
07.2016 - 03.2018
- Coordinated with multidisciplinary teams to optimize patient care delivery.
- Assisted nursing staff in providing patient care and managing daily activities in a fast-paced environment.
- Documented patient information accurately in electronic health records to ensure compliance.
- Assisted visitors and addressed internal and external phone calls with professionalism.
Education
High School Diploma -
Blaine Highschool
Blaine, MN06-2010
Skills
- Project management
- Cross-functional collaboration
- Relationship management
- Critical thinking
- Service recovery
- Process improvement
- Claims data analysis
Timeline
Provider Relations Advocate
UCare Minnesota
08.2023 - Current
Customer Service Representative Team Lead
UCare Minnesota
12.2021 - 08.2023
Customer Service Representative
UCare Minnesota
11.2020 - 12.2021
Clinic Assistant
Twin Cities Spine Center
03.2018 - 11.2020
Nursing Station Technician
Fairview Health Services
07.2016 - 03.2018
High School Diploma -
Blaine Highschool