Vanessa Guitron-Torres
Supervisor
San Antonio,Texas
Summary
Accomplished Claims Supervisor with a proven track record at UnitedHealth Group, enhancing operational efficiency and patient service through expert management of claims and team leadership. Skilled in Health Insurance Industry Knowledge and fostering a collaborative environment, I significantly improved productivity by implementing strategic workflows and training programs.
Overview
20
20
years of professional experience
Work History
Claims Supervisor
UnitedHealth Group
San Antonio, TX
08.2022 - 07.2024
- Develop and implement procedures for handling claims, ensuring compliance with applicable laws and regulations
- Collaborated with other departments such as IT, finance, operations to maximize efficiency throughout the organization
- Utilized strong organizational skills to develop efficient workflows, resulting in increased productivity and decreased costs
- Supervised and coordinated activities of staff to ensure compliance with established policies, procedures, and standards
- Oversaw real-time call volumes and production levels KPIs to maintain outstanding patient service.
- Responded to escalated client and patient concerns and assisted in researching clinical support
- Reviewed and revised sustainability proposals or policies
- Worked closely with upper management to develop strategies for improving operational efficiency within the department
- Assisted in the recruitment and selection of new claims adjusters, ensuring they possessed the necessary skills and expertise to excel in their roles
Urgent Care Supervisor
Med Express
San Antonio, Texas
04.2021 - 07.2022
- Oversaw the department of Registered Nurses, Administrative Assistants ,ensuring smooth workflow and timely completion of tasks.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
- Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.
- Enhanced communication within the team by holding regular meetings and encouraging open dialogue among all members.
- Resolved conflicts among team members promptly, maintaining a harmonious working environment conducive to productivity.
Utilization Management Coordinator
WellMed
San Antonio, Texas
08.2019 - 04.2021
- Streamlined communication process between providers nursing staff and case managers, reducing any delays in patient care.
- Maintained accurate documentation of all reviews, appeals, and decisions in line with organizational standards and requirements.
- Ensured regulatory compliance by staying updated on industry guidelines and applying them to daily tasks and assessments.
- Served as a liaison between patients, families, caregivers, providers, payers, and community resources to ensure seamless transitions throughout the continuum of care.
- Identified areas requiring resource optimization through trend analysis reports regularly.
- Facilitated effective communication between care teams, patients, and insurance companies, resulting in streamlined care coordination.
Supervisor Lead Pharmacy Technician II
CVS Caremark
San Antonio, Texas
01.2005 - 06.2019
- Develop and implement procedures for handling pharmacy mail order claims, ensuring compliance with applicable laws and regulations
- Collaborated with other departments such as IT, account receivable, pharmacist, patients , operations to maximize efficiency throughout the organization
- Utilized strong organizational skills to develop efficient workflows, resulting in increased productivity and decreased costs
- Supervised and coordinated activities of staff to ensure compliance with established policies, procedures, and standards
- Oversaw real-time call volumes and production levels KPIs to maintain outstanding patient service.
- Responded to escalated client and patient concerns and assisted in researching clinical support
- Reviewed and revised sustainability proposals or policies
- Worked closely with upper management to develop strategies for improving operational efficiency within the department
- Assisted in the recruitment and selection of new pharmacy technicians, ensuring they possessed the necessary skills and expertise to excel in their roles
Education
High School Diploma -
South San High School
San AntonioSkills
- Claim Validity Determination
- Health Insurance Industry Knowledge
- Managed Care
- Customer Service
- Multitasking
- Adaptability and flexibility
- Recruitment and hiring
- Project management
- Data analysis
- Performance monitoring
- Legal compliance
- Teamwork and collaboration
- Personnel training
Accomplishments
Frontline Leadership Program
Emotional Intelligence
Communicator
Additional Information
R E F E R E N C E S
Jenelle Pinto — United Healthcare
Manager
Phone: (724) 747-6315
jenellelpinto@gmail.com
Sharika Allen Odom—United Healthcare
Manager
Phone: (210) 213-3131
lallen702@gmail.co
Languages
English
Professional Working
Timeline
Claims Supervisor
UnitedHealth Group
08.2022 - 07.2024
Urgent Care Supervisor
Med Express
04.2021 - 07.2022
Utilization Management Coordinator
WellMed
08.2019 - 04.2021
Supervisor Lead Pharmacy Technician II
CVS Caremark
01.2005 - 06.2019
High School Diploma -
South San High School