Katty Vasquez
Bronx
Summary
Customer service professional with extensive experience in healthcare claims processing and member advocacy at UnitedHealth Group. Demonstrated ability to resolve complex issues and improve customer satisfaction through effective communication and problem-solving skills. Bilingual communicator skilled in navigating regulatory requirements and supporting informed decision-making for diverse populations.
Overview
4
4
years of professional experience
Work History
Customer Service Representative Sr., E&I Operations
UnitedHealth Group
10.2024 - 09.2025
- Address high-volume inquiries regarding medical, vision, dental, pharmacy, and claims-related issues, ensuring accurate documentation of all interactions.
- Review and explain eligibility, benefits, and claims decisions, including denied or pending claims, using clear, non-technical language.
- Research complex claims by utilizing multiple databases and cross-functional teams to expedite resolution and prevent future issues.
- Educate members on cost management strategies, including deductibles, out-of-pocket costs, and network benefits.
- Guide members to appeals and grievance processes when applicable, ensuring compliance with company and regulatory requirements.
- Meet and exceed key performance indicators (KPIs) including first call resolution, call quality, and customer satisfaction scores.
Plan Advisor
UnitedHealth Group
03.2024 - 10.2024
- Explained medical coverage, claim statuses, and pre-certification requirements to members and providers.
- Assisted with benefits verification and appeals submissions, helping members understand denial reasons and next steps.
- Clarified out-of-pocket costs, co-pays, deductibles, and plan details to promote informed decision-making.
- Partnered with clinical teams to resolve escalated claims and ensure compliance with benefit guidelines.
Inbound Care Navigator
Optum (UnitedHealth Group)
03.2023 - 12.2023
- Served as a patient advocate, providing non-clinical support during pre- and post-surgical care.
- Monitored patient engagement via a digital platform, connecting them with resources to overcome barriers to care.
- Assisted patients and providers with authorization and scheduling questions and explained care-related benefits.
- Documented interactions and patient updates in multiple systems, ensuring compliance with privacy standards.
- Delivered personalized support and customer service to patients and providers, improving care experiences.
Service Account Manager Associate
UnitedHealth Group
02.2022 - 03.2023
- Resolved claim disputes and escalations, investigating complex issues and providing clear, timely resolutions.
- Reviewed claim details to ensure accurate processing and identified root causes of errors or delays.
- Supported cross-functional teams with feedback to improve claims workflows and reduce errors.
Education
Bachelor of Science - Healthcare Management
Southern New Hampshire University
Manchester, NH06.2027
Skills
- Healthcare claims processing
- Benefit explanation
- Member advocacy
- HIPAA compliance
- Microsoft Office proficiency
- Bilingual communication
- Call center management
- Critical thinking skills
- Data entry expertise
- Customer service excellence
- Active listening skills
- New York Medicaid knowledge
- State benefit population expertise
- Medicare MLTC knowledge
Accomplishments
- Consistently achieved 95%+ first call resolution rate by thoroughly addressing member claims, benefit, and appeals inquiries.
- Reduced claims processing time by 20% through initiative-taking research and cross-department collaboration.
- Successfully assisted in over three hundred claims appeal submissions, improving resolution outcomes for members.
- Ranked in the top 10% of customer satisfaction surveys for call quality and communication clarity.
- Trained team members on claims escalation procedures and benefit explanation, improving overall team performance.
Languages
Spanish, Native or Bilingual
Languages
Spanish
Native/ Bilingual
Timeline
Customer Service Representative Sr., E&I Operations
UnitedHealth Group
10.2024 - 09.2025
Plan Advisor
UnitedHealth Group
03.2024 - 10.2024
Inbound Care Navigator
Optum (UnitedHealth Group)
03.2023 - 12.2023
Service Account Manager Associate
UnitedHealth Group
02.2022 - 03.2023
Bachelor of Science - Healthcare Management
Southern New Hampshire University
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