Liberato Yambao
North Hills,CA
Summary
Seasoned Manager with a proven track record at ANTHEM Health Services, specializing in operations management and team leadership. Expert in driving performance improvements and fostering customer relationships, achieving a significant reduction in process defects. Skilled in documentation and clear communication, adept at steering teams towards exceeding key performance indicators.
Overview
26
26
years of professional experience
Work History
Manager II
ANTHEM Health Services
Woodland Hills, CA
03.2017 - 02.2024
- Oversaw daily operations, maintaining efficiency and quality standards.
- Conducted performance evaluations, providing feedback and coaching for team development.
- Reviewed employee performance and provided ongoing feedback and coaching to drive performance improvement.
- Developed and implemented strategic plans to achieve company objectives.
- Managed vendor relationships by negotiating contracts and ensuring timely delivery of goods and services.
- Established processes to ensure efficient workflow throughout the organization.
Manager of Operations
Anthem
Woodland Hills, CA
07.2015 - 01.2017
- Oversaw financial management, budget management, accounting and payroll activities.
- Resolved conflicts among team members by mediating disputes and proposing solutions that both parties could agree upon.
- Ensured compliance with applicable laws and regulations related to operations.
- Oversaw staff training and development programs, equipping employees with necessary skills and knowledge.
- Ensured compliance with industry regulations and maintained high standards of operational excellence.
- Investigated customer complaints related to product and service quality or delivery issues.
- Prepared staff work schedules and assigned team members to specific duties.
- Managed day-to-day operations while ensuring high levels of customer satisfaction were met at all times.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Delegated work to staff, setting priorities and goals.
- Implemented quality control measures, achieving a reduction in defects and errors.
- Developed and maintained relationships with key stakeholders, including suppliers, customers, and partners.
- Enforced federal, state, local and company rules for safety and operations.
- Coordinated with other department heads to align operational activities with overall company objectives.
- Collaborated with other managers across the organization to develop strategies that support overall company objectives.
- Monitored team progress towards achieving milestones set forth in project plans.
Process Expert I, II
ANTHEM Health Services
Woodland Hills, CA
10.2010 - 05.2015
- Provided technical expertise during system integration projects.
- Developed strategies for streamlining operations while meeting customer demands.
- Assessed employees through on-site observation and interviews to determine strengths and weaknesses in work performance, methods, and team functions.
- Implemented unique methods and methodologies, which helped reduce, and resolve issues.
- Monitored performance metrics and prepared reports to track progress towards goals.
- Created workflow diagrams depicting each step in a given process.
- Troubleshot issues related to process execution and provided timely resolutions.
- Documented research findings and prepared polished reports highlighting results and potential improvement strategies.
- Led training sessions for personnel on new and existing processes, ensuring understanding of requirements.
- Evaluated internal systems and prepared training initiatives to mitigate ongoing problems.
- Performed research and analyzed content of records to make disclosure determinations.
- Evaluated new technologies that could be used to enhance existing processes.
- Conducted record searches and coordinated with other units on procedural problems involving complex cases.
- Facilitated brainstorming sessions with stakeholders to generate ideas for improvements.
- Provided technical guidance on process improvement projects, identifying root causes of process failures.
- Developed standard operating procedures for production processes, ensuring compliance with quality standards.
- Identified opportunities for automation through data analysis and predictive analytics tools.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
- Maintained updated knowledge through continuing education and advanced training.
Claims Team Leader
ANTHEM Health Services
Woodland Hills, CA
08.2005 - 09.2010
- Conducted regular meetings with the team to review workloads and ensure any potential risks were identified and addressed.
- Tracked progress of each claim to ensure it was handled in a timely manner.
- Input claim information and payments into company database.
- Verified liability extent with reviews of police reports, medical treatment histories and other records.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Analyzed information gathered by investigations and reported findings and recommendations.
- Reviewed existing policies and procedures for claims handling, making recommendations for changes as necessary.
- Gathered and documented evidence to support court proceedings.
- Coordinated with other departments within the organization to ensure smooth running of operations.
- Collaborated with other departments within the organization to ensure seamless communication between teams.
- Investigated potentially fraudulent claims with focus on thoroughness, quality, and cost control.
- Reduced loss ratios through fair and prompt processing of claims.
- Resolved escalated complaints from customers in an efficient manner.
- Identified areas where processes could be improved or streamlined.
- Liaised with IT department to troubleshoot any technical issues that may arise during claims processing.
- Scheduled training sessions for new staff members on company policies, systems and procedures related to claims handling.
Claims Quality Auditor
ANTHEM Health Services
Woodland Hills, CA
10.2003 - 10.2005
- Maintained up-to-date knowledge of regulatory changes affecting claims processing.
- Examined claims investigated by independent adjusters.
- Organized information by using spreadsheets, databases or word processing applications.
- Documented claim actions and decisions thoroughly for audit purposes.
- Identified discrepancies in claims data and initiated corrective action as needed.
- Interpreted federal regulations related to healthcare insurance plans.
- Participated in special projects as requested by departmental leadership.
- Provided training to new staff members on quality assurance processes.
- Analyzed and audited open claims to calculate additional payments owed.
- Processed claims payments and denials in accordance with company procedures.
- Interpreted policy terms and conditions to ascertain claim eligibility.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Developed reports on audit findings and recommended process improvements.
- Maintained detailed records on audit results, trends, issues, and recommendations.
- Recommended modifications to existing procedures based on audit findings.
- Coordinated with legal counsel on complex claims requiring litigation.
- Developed and implemented strategies to reduce claim processing times.
- Communicated with personnel and legal counsel on claims involving litigation.
Claims Processor I, II, III, SR
ANTHEM Health Services
Woodland Hills, CA
08.1999 - 07.2003
- Adhered to state and federal regulations regarding insurance claims processing.
- Applied knowledge of coding systems such as CPT-4 and HCPCS codes for proper reimbursement.
- Processed a high volume of incoming claims in accordance with established policies and procedures.
- Identified and flagged suspicious claims for further investigation.
- Reviewed and processed incoming insurance claims to ensure accuracy and completeness.
- Entered claim information accurately into database systems.
- Addressed customer inquiries to provide information and explanations on coverage and terms, expediting claims.
- Collaborated with fellow team members to manage large volume of claims.
- Analyzed and evaluated claim forms, medical reports, bills, and other documents to ensure accuracy of data.
- Corresponded with providers regarding any missing or incomplete documentation needed for successful adjudication of claims.
- Performed additional duties as requested by management team.
Customer Service Representative
ANTHEM Health Services
Woodland Hills, CA
08.1998 - 09.1999
- Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Maintained a high level of professionalism when dealing with difficult customers.
- Provided exceptional customer service to ensure customer satisfaction.
- Resolved customer complaints promptly and efficiently.
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Provided accurate information about products and services to customers.
- Conducted regular follow-up calls with customers after resolving their issues.
- Developed strong relationships with customers by providing personalized assistance and support.
Education
Some College (No Degree) - Medical Assistant
ICT Collage
Los Angeles, CASkills
- Documentation and reporting
- Clear communication
- Change management
- Customer relationship management (CRM)
- Team leadership
- Trend analysis
- Work prioritization
- Key performance indicators
- Product management
- Business development
- Staff training and development
- Inventory management
- Policy and procedure development
- Employee onboarding
- Performance management
- Staff management
- Operations management
- Performance evaluations
- Conflict resolution
- Workforce management
- Goal setting
References
References available upon request.
Timeline
Manager II
ANTHEM Health Services
03.2017 - 02.2024
Manager of Operations
Anthem
07.2015 - 01.2017
Process Expert I, II
ANTHEM Health Services
10.2010 - 05.2015
Claims Team Leader
ANTHEM Health Services
08.2005 - 09.2010
Claims Quality Auditor
ANTHEM Health Services
10.2003 - 10.2005
Claims Processor I, II, III, SR
ANTHEM Health Services
08.1999 - 07.2003
Customer Service Representative
ANTHEM Health Services
08.1998 - 09.1999
Some College (No Degree) - Medical Assistant
ICT Collage
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