Riena Sabrina Sayago
North Las Vegas,NV
Summary
Passionate Business Leader with over 19 years of experience, I have consistently driven organizational success through strategic vision, innovative solutions and a commitment to excellence.
Professional with comprehensive understanding of business process improvement and optimization, consistently delivering impactful solutions. Known for collaborative approach and focus on achieving results, adapting seamlessly to evolving business needs. Skilled in process analysis, change management, and fostering team collaboration.
Overview
20
20
years of professional experience
Work History
Business Process Consultant Market Advocacy
Optum Healthcare
06.2021 - Current
- Data Management & Manipulation: Handle and manipulate mostly structured data. Perform analysis of complex data, identify root causes, synthesize findings, and present recommendations for operational improvement.
- Pattern & Trend Analysis: Conduct analysis to identify patterns and trends. Develop, explain and execute analytical strategies to support organizational. Identify claims trends and patterns in data to provide insights for business decisions.
- Data Normalization & Quality Assurance: Perform normalization operations and ensure data quality. Execute analytical strategies to support organizational goals and improve operational efficiency.
- Data Solutions Development: Create solutions to support data analysis. Support process improvements, monitor outcomes, and ensure adoption of new processes. Stay up to date with latest data analytics tools.
- Recommendations Presentation: Present recommendations for use across the company. Prepare monthly data sets and manage multiple analytical engagements. Represent and facilitate meeting and presentations.
- Stakeholder Collaboration: Partner with stakeholders to understand data requirements. Collaborate with stakeholders to develop data-driven solutions and communicate findings and influence outcomes. Build and maintain key relationships with market operational leaders, network managers, and providers.
- Software Utilization: Use business intelligence, data visualization, query, analytic, and statistical software.
- Descriptive & Regression-Based Analytics: Work on descriptive and regression-based analytics.
- Subject Matter Expert Collaboration: Leverage subject matter expert views in designing analytics, reviewing claims data and proactive monitoring for trends in my markets.
Supervisor Claims Rework Team
Optum Healthcare
06.2020 - 06.2021
- Team Supervision: Supervised a team of 15, resolving complex issues for providers, market operations, and customers.
- Team Transformation: Transformed an underperforming, dissatisfied team into a top-performing group where everyone enjoyed their work.
- Daily Operations Oversight: Oversee daily operations, ensuring financial and non-financial results meet department goals.
- Claims Processing & Trend Analysis: Provide expertise in claims processing, trend analysis, and implementation of new initiatives.
- Team Coordination & Development: Coordinate team meetings, provide coaching, feedback, and performance reviews.
- Operational Problem Solving: Identify and resolve operational problems using defined processes and judgment.
System Master Expert Claims
Optum Healthcare
10.2018 - 06.2020
- Complex Claims Resolution: Resolve complex claims issues for team members and internal customers.
- Team Coordination & Conflict Resolution: Coordinate team meetings and provide coaching to resolve conflicts.
- Procedure Updates & Training Support: Support implementation of procedure updates and new system training.
- Trend Analysis & Reporting: Analyze and identify trends, providing necessary reports.
- Mentorship & Project Management: Mentor team members and manage special projects and process improvements.
Claim Representative Senior
UnitedHealthcare
05.2014 - 10.2018
- Benefits Application: Ensure that proper benefits are applied to every claim.
- Claims Processing: Apply appropriate processes and procedures to process claims.
- Regulatory Knowledge: Apply knowledge of applicable laws, HIPAA, PPACA.
- New Plans/Customers: Identify and apply knowledge of new plans/customers to process their claims appropriately.
- Product/Service Knowledge: Demonstrate knowledge of applicable product/service offerings and the value they provide to members and providers.
- Data Research & Identification: Research, identify, and obtain data/information needed to help process claims or resolve claims issues.
- Internal Collaboration: Collaborate with internal business partners to resolve claims errors/issues.
- System Navigation: Navigate systems tools and screens efficiently and effectively.
Dental Claim Representative II
UnitedHealthcare
05.2013 - 05.2014
- Dental Claims Adjudication: Adjudicate dental claims, meeting production and quality standards.
- Claims Issue Resolution: Research and resolve dental claims issues, ensuring accuracy.
- Quality & Production Standards: Consistently met and exceeded production and quality standards for the last year.
- Service Forms & Correspondence: Worked on service forms and dental correspondence, researching all issues.
- Claims Analysis: Analyze dental claims to ensure accuracy, including review of dental x-rays.
- Problem Identification & Reporting: Identify any problems and write up for Dental Director review.
- Timely Issue Resolution: Investigate and research all issues in a timely manner.
Dental Claim Representative Associate
UnitedHealthcare
10.2010 - 05.2013
- Dental Claims Adjudication: Adjudicate dental claims, meeting production and quality standards.
- Claims Issue Resolution: Research and resolve dental claims issues, ensuring accuracy.
- Quality & Production Standards: Consistently met and exceeded production and quality standards for the last year.
- Service Forms & Correspondence: Worked on service forms and dental correspondence, researching all issues.
- Claims Analysis: Analyze dental claims to ensure accuracy, including review of dental x-rays.
- Problem Identification & Reporting: Identify any problems and write up for Dental Director review.
- Timely Issue Resolution: Investigate and research all issues in a timely manner.
Recovery Representative CIR
UnitedHealthcare
11.2007 - 10.2010
- Check Processing & Claims Adjustment: Investigate and process checks, adjust claims, and manage member eligibility.
- Customer Service: Provide excellent customer service and manage incoming calls.
- Claims Investigation: Research, investigate, and adjust claims and claim issues, overseeing CSF/ISF.
- Member Eligibility Management: Work on member termination and reinstatement reports by verifying eligibility and processing accordingly.
- Collection Letters: Send out collection letters to providers and members on accounts where monies are due to the company.
- Problem Solving: Analyze and solve customer problems in office and on phones, overseeing DRG audits and HIPAA violations.
- Call Management: Manage incoming calls from providers and members on accounts, providing excellent customer service.
Administrative Support BSL
UnitedHealthcare
08.2005 - 11.2007
- Administrative Liaison: Served as an administrative liaison between members and providers, routing inquiries for appropriate assistance in the recovery, subrogation, and COB departments.
- Record & Report Maintenance: Maintained departmental records and reports, formatted graphs, scheduled appointment calendars for meetings, and prepared and distributed meeting minutes.
- Departmental Flexibility: Remained flexible to assist the entire department in operating smoothly, performing multiple responsibilities as needed by management.
- Vendor Reports & Commission Checks: Managed all vendor reports and commission checks for BNS outside vendor.
Education
Associate’s degree - business medical office administration
Lake Tahoe Community College
South Lake Tahoe, CASkills
- Adaptable learner
- Inquisitive mindset
- Analytical reasoning
- Effective issue management
- Experience in delivering impactful presentations
- Experienced with Microsoft Word
- Excel spreadsheet management skills
- Presentation design
- SharePoint and Power BI integration
- Cross-functional team leadership
- Team building and motivation
- Data-driven decision making
- Innovation and creativity
- Teamwork and collaboration
Accomplishments
- Supervised team of 15 staff members.
- Documented and resolved [Issue] which led to [Results].
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Achieved [Result] by completing [Task] with accuracy and efficiency.
- Collaborated with team of [Number] in the development of [Project name].
Timeline
Business Process Consultant Market Advocacy
Optum Healthcare
06.2021 - Current
Supervisor Claims Rework Team
Optum Healthcare
06.2020 - 06.2021
System Master Expert Claims
Optum Healthcare
10.2018 - 06.2020
Claim Representative Senior
UnitedHealthcare
05.2014 - 10.2018
Dental Claim Representative II
UnitedHealthcare
05.2013 - 05.2014
Dental Claim Representative Associate
UnitedHealthcare
10.2010 - 05.2013
Recovery Representative CIR
UnitedHealthcare
11.2007 - 10.2010
Administrative Support BSL
UnitedHealthcare
08.2005 - 11.2007
Associate’s degree - business medical office administration
Lake Tahoe Community College
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