Jessica Bustamonte
Kerman,CA
Summary
Dedicated and experienced healthcare operations professional with a proven track record in program management, data analysis, and process improvement. Seeking to leverage expertise to contribute to the success of company and work environment.
Overview
26
26
years of professional experience
Work History
Operations Specialist
Compass Health Administrators
Fresno, CA
03.2024 - 01.2025
- Managed inventory and logistics, ensuring timely claim processing
- Utilized data analytics to monitor performance metrics and identify areas for improvement
- Spearhead initiatives to improve operational management systems, processes, and best practices
Operations Manager
Compass Health Administrators
Fresno, CA
11.2021 - 03.2024
- Lead Management Team meetings to develop and implement strategic program goals and objectives
- Trained and mentored staff, fostering a culture of continuous improvement and professional development
- Developed and executed strategic plans that improved operational workflows and supported business objectives
Benefits Specialist
Compass Health Administrators
Fresno, CA
11.2017 - 11.2021
- Ensure benefits compliance with all appropriate federal, state and local laws
- Assist with communication and education to personnel and former personnel about benefit programs, procedures, changes and government-mandated disclosures
- Provide exceptional customer service to office HR, vendors and all personnel, answering benefit questions in a timely manner and resolving problems related to payment of benefits, benefit plan eligibility and enrollment
Benefits Specialist
Advantek Benefit Administrators
Fresno, CA
11.2015 - 11.2017
- Managed system configurations for various health plan groups, including payor systems, charge menus, and coding updates
- Played a key role in the administration of plan benefits and the resolution of benefit-related issues
- Conducted thorough claims auditing to ensure accuracy and compliance
Claims Examiner
Delta Health Systems
Fresno, CA
11.2007 - 11.2015
- Evaluated and processed insurance claims, ensuring adherence to policy terms and regulatory requirements
- Collaborated with healthcare providers and policyholders to resolve claims disputes
- Verify eligibility for coverage and determine coordination of benefits
Service Consultant
Aetna
Fresno, CA
07.1999 - 02.2006
- Provided expert consultation services to clients regarding insurance plans and services
- Implemented quality service related to customer service protocols
- First call resolution for members and providers, with claim handling
Education
College -
Fresno City College
Fresno, CA01.1993
High School -
Kerman High School
Kerman, CA01.1992
Skills
- Operations Management
- Inventory and logistics management
- Strategic planning and implementation
- Performance metrics monitoring and data analytics
- Process improvement and best practices implementation
- Benefits Administration
- Benefits compliance and communication
- System configuration for health plan groups
- Claims auditing and resolution
- Customer service and support
- Leadership and Team Management
- Staff training and mentoring
- Leading management team meetings
- Fostering a culture of continuous improvement
- Professional development initiatives
- Claims Processing
- Insurance claims evaluation and processing
- Collaboration with healthcare providers and policyholders
- Expert consultation services
- Customer Service
- Handling complex claims
- Resolving benefit-related issues efficiently
- Providing expert consultation services
References
Available upon request.
Leadership Experience
Effective leadership is crucial for successful operations management. Inspire and lead teams, manage staff performance, and develop talent within the organization. Be adept at conflict resolution, team building, and creating an environment that promotes growth and high performance.
Communication Skills
Communicate clearly with team members, stakeholders, and other departments. Foster collaboration and maintain positive relationships. Active listening and empathy are essential.
Timeline
Operations Specialist
Compass Health Administrators
03.2024 - 01.2025
Operations Manager
Compass Health Administrators
11.2021 - 03.2024
Benefits Specialist
Compass Health Administrators
11.2017 - 11.2021
Benefits Specialist
Advantek Benefit Administrators
11.2015 - 11.2017
Claims Examiner
Delta Health Systems
11.2007 - 11.2015
Service Consultant
Aetna
07.1999 - 02.2006
College -
Fresno City College
High School -
Kerman High School