Open To Work
Katty Vasquez
Molina Healthcare of New york
Bronx,NY
20
Language
25
Years of experience
Results-oriented professional focused on enhancing team performance and operational efficiency through targeted training and strategic feedback. Proven expertise in leveraging data-driven insights to improve team dynamics and streamline processes. Experienced in healthcare claims processing and member advocacy, adept at resolving complex issues and improving customer satisfaction. Bilingual communicator proficient in navigating regulatory requirements and supporting informed decision-making for diverse populations.
Work History
Manager Team Support
9 Months- Monitored team dynamics and provided actionable feedback to enhance collaboration.
- Analyzed team performance metrics to identify areas for improvement and drive operational efficiency.
- Facilitated the coordination of team activities and ensured alignment with organizational goals.
- Coordinated team activities to align with organizational goals and improve synergy.
- Managed resource allocation and scheduling to optimize team output and effectiveness.
- Established clear roles and responsibilities to promote accountability within the team.
- Conducted regular check-ins with team members to ensure alignment and address any concerns promptly.
- Encouraged innovative thinking and problem-solving among team members to drive better outcomes.
- Conducted regular check-ins with team members to maintain alignment and promptly address concerns.
- Collaborated with cross-functional teams to support project initiatives and enhance overall team success.
Customer Service Representative Sr.
7 Months- Managed high-volume inquiries on medical, vision, dental, pharmacy, and claims-related issues, ensuring accurate documentation and enhancing member experience. 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. Informed members on cost management strategies like deductibles, out-of-pocket costs, and network benefits, promoting informed decision-making. Guided members to appeals and grievance processes, ensuring compliance with company and regulatory requirements. Meet and exceed key performance indicators (KPIs) including first call resolution, call quality, and customer satisfaction scores.
- Resolved member inquiries regarding benefits, eligibility, and claims using guided call workflows.
- Documented case notes accurately in customer relationship systems for compliant follow-up.
- Explained plan coverage, copays, and authorizations in clear, professional language.
Plan Advisor
7 Months- Explained medical coverage, claim statuses, and pre-certification requirements to members and providers, enhancing their understanding of available benefits. Assisted with benefits verification and appeals submissions, facilitating member comprehension of denial reasons and guiding them on next steps. Clarified out-of-pocket costs, co-pays, deductibles, and plan details, enabling members to make informed decisions about their healthcare options. Partnered with clinical teams to resolve escalated claims and ensure compliance with benefit guidelines.
- Advised members on benefits, eligibility, and claim inquiries using UnitedHealthcare policies and systems.
- Resolved complex service issues by coordinating with internal teams and external providers.
- Interpreted plan documents to guide members through coverage, referrals, and prior authorization requirements.
Inbound Care Navigator
9 Months- Acted as a patient advocate, providing non-clinical support during pre- and post-surgical care. Monitored patient engagement on digital platform, connecting patients with resources to address barriers to care. Assisted patients and providers with authorization, scheduling questions, and explained care-related benefits to facilitate access to services. Documented interactions and patient updates in multiple systems, ensuring compliance with privacy standards. Provided personalized support and customer service to patients and providers, enhancing overall care experiences.
- Coordinated member care plans, scheduling follow-ups and supporting referral completion.
- Documented outreach, assessments, and care updates in electronic health records accurately.
- Collaborated with clinical teams to resolve gaps in care and streamline member navigation.
Service Account Manager Associate
1 Year 1 Month- Resolved disputes and escalations by investigating complex issues and delivering clear, timely resolutions to enhance customer satisfaction. Reviewed claim details for accurate processing and identified root causes of errors or delays, contributing to improved claims handling. Supported cross-functional teams with feedback to refine claims workflows, leading to reduced errors and smoother operations.
- Managed client relationships and resolved escalated benefit, claims, and eligibility issues.
- Coordinated with internal teams to support account setup, renewals, and service delivery.
- Reviewed plan performance and identified service gaps to improve client satisfaction.
Education
Bachelor - Public Health
Skills
- Claims Analysis
- Benefit explanation
- Medicare expertise
- New York Medicaid knowledge
- Regulatory Compliance
- HIPAA compliance
- Cross-Functional Collaboration
- Problem solving
- Critical thinking skills
- Customer service expertise
- Customer service skills
- Customer Engagement
- Microsoft Office skills
- Member advocacy
Languages
Spanish Native
Personal Information
Title: Manager Team Support | Customer Service Representative Sr. | Plan Advisor | Inbound Care Navigator | Service Account Manager Associate
Work Preference
Job Search Status:
Open to work
Work Type
Part TimeContract WorkFull Time
Location Preference
Remote
Minimum Desired Compensation
$24/hr
Timeline
Manager Team Support
Molina Healthcare of New york
10.2025 - 07.2026Read More
Customer Service Representative Sr.
UnitedHealth Group
10.2024 - 05.2025Read More
Plan Advisor
UnitedHealth Group
03.2024 - 10.2024Read More
Inbound Care Navigator
Optum (UnitedHealth Group)
03.2023 - 12.2023Read More
Service Account Manager Associate
UnitedHealth Group
02.2022 - 03.2023Read More
BMCC
Bachelor from Public Health
Read More