VANESSA GUITRON TORRES
San Antonio,TX
Summary
A results-driven healthcare professional with over 20 years of experience in claims management, process optimization, and team leadership. Adept at streamlining operations, enhancing efficiency, and ensuring compliance with regulatory standards. Demonstrated success in managing complex workflows, resolving customer escalations, and training high-performing teams. Skilled in data analysis, utilization management, and driving continuous process improvements. Proven ability to deliver impactful results in high-pressure environments while maintaining a strong focus on customer satisfaction.
Overview
20
20
years of professional experience
Work History
Claims Supervisor
UnitedHealth Group, Optum Technology
San Antonio, USA
08.2022 - 07.2024
- Develop and implement procedures for handling claims, ensuring compliance with applicable laws and regulations
- Resolve escalated customer complaints in a professional manner while protecting company interests
- Provide training to new employees on proper claim filing procedures and documentation requirements
- Review submitted documents for accuracy prior to authorizing payments for completed claims
Urgent Care Supervisor
Med Express UnitedHealth Group, Optum Technology
San Antonio, USA
04.2021 - 07.2022
- Supervised and coordinated activities of staff to ensure compliance with established policies, procedures, and standards
- Monitored real time call volumes/production levels, and allocated available resources to ensure superior service for patients
- Responded to escalated client and patient concerns and assisted in researching clinical support
- Reviewed and revised sustainability proposals or policies
Utilization Management Coordinator
WellMed Medical Management - United Health Group
San Antonio, USA
08.2019 - 04.2021
- Prepared authorization cases for Medical Directors, UM Nurses and Case Managers
- Worked with claims department to redirect claims related appeal requests
- Provided data entry, filing, tracking time frames and status of case files and mailing letters to patients and providers
- Determined member eligibility, authorization and notification requirements
- Maintained knowledge of various health plan Policies
Supervisor Lead Pharmacy Technician II
CVS Caremark
San Antonio, USA
01.2005 - 06.2019
- Provided immediate and direct supervision of all non-dispensatory functions conducted by pharmacy technicians, interns, messengers and ancillary staff
- Established goals and objectives for unit and employees and integrated work unit standards and goals
- Maintained expertise in core pharmacy technician job functions, medication preparation, delivery, technology and automation support, and telephone triage
- Monitored workflow processes to ensure accuracy and timeliness of deliverables
- Created detailed reports summarizing daily operations, progress towards objectives, and potential areas of improvement
Education
High School Diploma -
South San High School
Skills
- Claims Management
- Regulatory Compliance (CMS, HIPAA)
- Utilization Management
- Data Analysis
- Project Management
- Healthcare Software Tools
- Medical Terminology
- Microsoft Office Suite
- Quality Assurance and Auditing
- Staff Training and Development
- Team Leadership
- Problem Solving
- Customer Service Excellence
- Conflict Resolution
- Communication
- Time Management
- Adaptability
- Collaboration
- Decision Making
- Attention to Detail
References
References Available on Request
Activities
Frontline Leadership Program
Emotional Intelligence
Communicator
Timeline
Claims Supervisor
UnitedHealth Group, Optum Technology
08.2022 - 07.2024
Urgent Care Supervisor
Med Express UnitedHealth Group, Optum Technology
04.2021 - 07.2022
Utilization Management Coordinator
WellMed Medical Management - United Health Group
08.2019 - 04.2021
Supervisor Lead Pharmacy Technician II
CVS Caremark
01.2005 - 06.2019
High School Diploma -
South San High School