Maria Garriga
Cape Coral,FL
Overview
30
30
years of professional experience
Work History
Director of Claims Operations
Preferred Medical Plan
Coral Gables, FL
01.1996 - 11.2017
- Developed and implemented strategies to improve operational efficiency, reduce costs, and enhance customer satisfaction.
- Analyzed data related to claims operations to identify areas of improvement and develop action plans for implementation.
- Managed the development of training materials and conducted ongoing training sessions for staff on new procedures and processes.
- Monitored performance metrics related to claims processing times, accuracy, quality assurance, customer service levels, and cost containment goals.
- Reviewed individual claim files for accuracy and compliance with policies and regulations.
- Coordinated with internal departments such as IT, Human Resources, Accounting, Legal Services. to ensure that all relevant information was available for decision making purposes.
- Oversaw the resolution of escalated issues related to claims operations in a timely manner.
- Collaborated with other departments within the organization to develop strategies for improving overall operational effectiveness.
- Conducted regular meetings with staff to discuss current projects, initiatives and provide feedback, guidance regarding best practices.
- Participated in industry forums and conferences to stay abreast of emerging trends in claims operations management.
- Ensured compliance with all applicable laws and regulations governing claims operations activities within the organization's jurisdiction.
- Implemented process improvements by leveraging technology solutions when appropriate.
- Analyzed financial documents such as budgets, forecasts, invoices. related to claims operations activities in order to ensure accurate reporting of expenses and costs associated with these functions.
- Provided leadership during organizational change initiatives by establishing clear expectations for staff members involved in transitioning into new roles or responsibilities.
- Performed root cause analysis on recurring issues within the department in order to identify potential solutions or corrective actions needed.
- Established strong relationships with external vendors providing services related to claims operations in order to ensure optimal service delivery at competitive rates.
- Created reports detailing key performance indicators related to claims operations activities in order to monitor progress against established goals and targets.
- Evaluated existing procedures and processes regularly in order determine whether changes should be made based upon changing market conditions or customer needs.
- Maintained regular performance appraisals for subordinates through verbal, written and on-going review programs.
- Oversee Coordination of Benefits, Claims Customer Service as well as system benefits configuration according to benefit plans.
Claims Manager
Family Health Plan
Miami Lakes
01.1988 - 06.1995
- Responsible supervision of 15 employees.
- Responsible for ensuring department's service standard and productivity standards were met as well as deadlines.
- Responsible for claims inventory as well as claims' lag report.
- Maintain claims adjudication system with most current Medicare and
- Medicaid fee schedules, as well as contracted physician and hospital fee schedules.
- Performed annual claims staff reviews, on going training on current and new claims procedures.
- Interacted with authorization, provider relations and member services to resolve claims issues.
Skills
- Operational Reporting
- Financial Resource Management
- Data Analysis
- Quality Assurance
- Business Relationship Management
- Problem resolution
- People skills
- Teambuilding
- Relationship building
- Computer skills
- Planning & organizing
- Fluent in Spanish
- Decision-making
- Customer service
- Organization
- Good work ethic
Timeline
Director of Claims Operations
Preferred Medical Plan
01.1996 - 11.2017
Claims Manager
Family Health Plan
01.1988 - 06.1995