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
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
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
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
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
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