Katherine Martinez
Tampa,FL
Summary
An accomplished leader offering 10 years of Medicaid and Medicare experience directing both claims and customer service operations in the insurance industry. A proven management professional with a demonstrated expertise in the development and execution of strategic plans and internal controls to improve operations, influence business growth, and maximize revenue through achievements in operations management. Excellent communication and interpersonal skills serve as a foundation to establish and maintain positive business relationships. Organized, focused professional with the ability to implement multifaceted projects simultaneously while working alone or as an integral part of a team.
Overview
10
10
years of professional experience
Work History
Senior Claims Manager (Medicaid Disputes)
Elevance Health
02.2020 - Current
- Oversight of dispute inventory/workload to be consistent with market and corporate contractual agreements, procedures, best practices and regulations.
- Led cross-functional teams in the development of innovative solutions to reduce dispute rates within the department.
- Facilitated collaboration between departments for more efficient resolution of interrelated claims issues.
- Championed continuous improvement initiatives that streamlined processes and enhanced overall department efficiency.
- Analyzed business processes to identify cost savings and operational efficiencies.
- Documented and communicated timely claims information while supporting accurate outcomes.
- Consistently met or exceeded key performance indicators for dispute resolution and provider documentation timeframe
Claims Supervisor(Medicaid)
Wellcare
08.2019 - 02.2020
- Successful oversight of Medicaid claims inventory, appeals, and correspondence for multiple markets (states)
- Consistent communication with stakeholders and vendors across multiple markets for successful reduction in claim inventory
- Documented and communicated timely claims information while supporting accurate outcomes.
- Root cause analysis and report trending for continual improvement and elevation of the department.
- Fostered a positive work environment that promoted collaboration, teamwork, and open communication among staff members.
- Monitored team performance, enforcing compliance with corporate claims processes and procedures.
Claims Supervisor(Medicare)
Cognizant Technology Solutions
08.2018 - 08.2019
- Partnership with team leads, peers, leaders and business partners for successful market launch and oversight
- Creation and implementation of rewards and recognition program
- Successful execution of the department’s programs which include reporting to external partners
- Execution of calibration sessions both internally/externally with the client.
Quality Assurance Supervisor/Contact Center Supervisor
Cognizant Technology Solutions
09.2016 - 07.2019
- Achieved consistent compliance with industry regulations by conducting thorough audits and ensuring adherence to standards.
- Collaborated with cross-functional teams to drive continuous improvement initiatives throughout the organization.
- Enhanced team performance by providing regular training, feedback, and guidance to Quality Assurance staff.
- Championed a culture of quality awareness, fostering employee engagement in maintaining high standards across all operations.
- Maintained comprehensive documentation of QA activities, supporting effective communication between departments and facilitating process improvements.
- Analyzed data from quality metrics to identify trends and opportunities for improvement, driving targeted action plans based on findings.
- Completed Six Sigma Green Belt Training.
Quality Supervisor (Care, Caid, Commercial)
Health Plan Services
01.2014 - 09.2016
- Successful oversight of team production ensuring adherence to monthly deadlines
- Established a culture of continuous improvement by regularly soliciting feedback from team members, recognizing their contributions, and implementing suggestions for process enhancements.
- Conducted root cause analyses on recurring defects leading to long-lasting solutions and increased customer satisfaction.
- Conducted thorough audits of calls to identify potential risks and implement corrective measures proactively.
- Maintaining strong relationships with the carriers and vendors through with fluid and consistent communication
- Participated in LEAN Sigma training and various company-wide process improvement projects.
Education
Associate of Arts - Education
Miami Dade College
Miami, FLSkills
- Analytical Thinking
- Problem-Solving Skills
- Relationship Building
- Quality Improvements
- Performance Monitoring
- Issue Resolution
- Team Collaboration
- Data Analysis
- Process Improvement
- Certified Yellow Belt Lean Six Sigma
- Bilingual (Spanish)
Timeline
Senior Claims Manager (Medicaid Disputes)
Elevance Health
02.2020 - Current
Claims Supervisor(Medicaid)
Wellcare
08.2019 - 02.2020
Claims Supervisor(Medicare)
Cognizant Technology Solutions
08.2018 - 08.2019
Quality Assurance Supervisor/Contact Center Supervisor
Cognizant Technology Solutions
09.2016 - 07.2019
Quality Supervisor (Care, Caid, Commercial)
Health Plan Services
01.2014 - 09.2016
Associate of Arts - Education
Miami Dade College
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