Veronica M Garcia
San Antonio,TX
Summary
Accomplished professional with a strong background in leadership and organizational management. Demonstrated ability to excel in detail-oriented, customer-centric positions while utilizing advanced skills in Microsoft Office and virtual communication tools. Committed to delivering results in a supportive, limited and/or non-speaking role.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Licensed Insurance Customer Service & Sales Professional III
USAA
San Antonio, Tx
10.2023 - Current
- Help members with insurance products and services by providing advice, binding new business, and handling policy, billing, and payment processing.
- Adjusted to dynamic schedules based on business needs and updated call flows.
- Transitioned seamlessly between fast-paced call center and quieter home office environments.
- Effectively use a variety of computerized systems and reference materials.
- Assisted members with insurance quotes and policy modifications for home, renters, auto, and valuable personal property.
- Provided tailored advice and solutions to align with member needs and budgets.
- Diagnosed issues effectively, reducing escalation rates significantly.
- Maintain state registrations and licenses.
- Performs all other related duties as assigned.
- Maintained high-quality service and support for each member in varying work settings.
Owner
Veronica's Cakery
San Antonio, TX
08.2004 - Current
- Direct and take part in operational activities such as preparing and baking items, controlling inventory, executing marketing plans, handling bookkeeping, driving sales efforts, and fulfilling general management roles.
- Promoted business on social media platforms to maximize brand identity and generate revenue.
- Created marketing campaigns to attract new customers.
- Implemented quality assurance processes to ensure product excellence.
- Created effective business plans to focus strategic decisions on long-term objectives.
- Employed and managed vendors by negotiating deliverables, cost and expected quality.
- Researched potential partners in order to expand services offered.
- Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
Medical Claims Review Coordinator
UnitedHealth Group/Optum
San Antonio, Tx
08.2022 - 08.2023
- Supported Utilization Management department with administrative functions for determinations and appeal coordination.
- Exceeded performance criteria for quality, accuracy, reliability, and productivity under established guidelines.
- Utilized Medicare and state HMO guidelines to ensure compliance with Utilization Management plan in data entry and letter preparation.
- Employed various computerized systems and reference materials effectively.
- Reviewed pended Live Claims and Retrospective Authorizations for duplicates, denials, and referrals.
- Assessed Live Claims for authorization mismatches and claims pending due to system issues.
- Conducted retrospective reviews for medical necessity and payment disputes related to Level of Care.
- Collaborated with departments to gather necessary information for claims resolution.
MHBP Member Advocacy Center, Senior Service Advocate
Aetna
San Antonio, Tx
08.2019 - 08.2022
- Acted as primary point of contact for inquiries related to Post Call Survey Alerts and escalated issues.
- Consistently exceeded performance benchmarks in quality, accuracy, reliability, and productivity.
- Engaged members and providers through various communication methods including phone and email.
- Conducted thorough research on member concerns using diverse computerized systems, ensuring proper documentation.
- Supported resolution of escalated issues through effective callback assistance.
- Served as Subject Matter Expert during training of new hires and on the production floor.
- Delivered training sessions and coaching to address complex challenges faced by team members.
- Developed call calibration processes to maintain high-quality standards across evaluations.
- Developed strategies for improving overall efficiency of the department's workflow.
- Advised on policy development and assisted in community program implementation.
- Provided training support for new staff members on company policies and procedures related to service delivery.
- Responded to inquiries about transplants, HRAs, HSAs, and benefits from Consumer Option Group.
- Processed medical claims efficiently as required.
- Clarified authorizations, claims, denials, and coordination of benefits for consumers.
- Managed eligibility assessments to ensure accurate benefit access.
MHBP Consumer Option Senior Customer Service Representative
Aetna
San Antonio, Tx
07.2017 - 08.2019
- Served as primary contact for members, providers, and staff to resolve inquiries per plan contract rules.
- Maintained key performance criteria, achieving high standards in quality, accuracy, and productivity.
- Addressed questions on transplants, HRAs, HSAs, benefits, authorizations, claims, denials, and eligibility.
- Developed training guides for new team members within Consumer Option Group.
- Created and distributed user-friendly COB templates and job aids for document uploads.
- Participated in outbound call projects to support 2018 HSA Migration to PayFlex initiative.
- Assisted with PayFlex eligibility vetting through effective communication and follow-up efforts.
MHBP Senior Customer Service Representative
Aetna
San Antonio, Tx
03.2017 - 07.2017
- Served as primary contact for members, providers, and staff to resolve inquiries and issues according to plan contract rules.
- Communicated with members, providers, and staff through various channels including phone, email, and fax.
- Researched member information using computerized systems to address concerns and documented all interactions.
- Monitored call volumes to determine when to allocate representatives for Post Call Work and completed Interval Reports as necessary.
- Assisted with escalated issue callbacks to ensure prompt resolution.
- Functioned as Subject Matter Expert on production floor and during new hire training sessions.
- Provided training and coaching on complex issues to enhance team performance.
HICS Escalations Senior Health Concierge
Aetna
San Antonio, Tx
04.2016 - 03.2017
- Processed complaints from Center of Medicare/Medicaid Services regarding Healthcare Exchange Plans.
- Served as backup for priority case team and supervisors as needed.
- Documented grievances related to clinical and non-clinical services for Medicare Grievance Team.
- Initiated acknowledgment notices detailing grievance resolution timelines per CMS guidelines.
- Engaged in bi-weekly mentoring and leadership development sessions with management team.
HICS Escalations Health Concierge
Aetna
San Antonio, Tx
09.2015 - 04.2016
- Processed complaints from Center for Medicare and Medicaid Services regarding Healthcare Exchange Plans by Coventry and Aetna.
- Executed, analyzed, and presented Root Cause Analysis projects to identify systemic issues.
- Conducted Internal Quality Assurance projects to enhance operational standards.
- Provided quality assurance feedback to Processors and Management for continuous improvement.
- Developed training materials for updated processes and facilitated training sessions.
- Participated in Senior In Training program to enhance leadership skills and professional growth.
HICS Escalations Associate Health Concierge
Aetna
San Antonio, Tx
11.2014 - 09.2015
- Processed escalated complaints from Center of Medicare/Medicaid Services regarding Healthcare Exchange Plans administered by Coventry/Aetna.
- Researched member information using internal technical tools and reference materials to ensure compliance with guidelines.
- Investigated and analyzed escalated inquiries, taking responsibility for issue resolution.
- Maintained accurate documentation of research findings and all customer interactions.
- Communicated with members, providers, and staff via phone, written correspondence, fax, web, and email.
- Assisted management with additional projects or duties as required.
- Served as Subject Matter Expert on production floor and in training environments.
Associate Health Concierge
Aetna
San Antonio, Tx
04.2014 - 11.2014
- Served as primary contact for members and providers to resolve inquiries per plan contract rules.
- Researched member information using internal tools to ensure compliance with guidelines.
- Investigated and analyzed escalated issues, ensuring thorough follow-up on resolutions.
- Maintained accurate documentation of research outcomes and customer interactions.
Quality Support and Data Analyst I
JP Morgan Chase
San Antonio, Tx
10.2011 - 03.2014
- Evaluated phone interactions and cases to assess customer service quality and regulatory adherence across Retail Banking CSO.
- Assisted in executing and analyzing Root Cause Analysis projects to identify improvement opportunities.
- Tested internal controls for compliance with governmental regulations, analyzing results and escalating findings.
- Maintained accurate documentation of research outcomes and all interactions to resolve outstanding issues.
- Led and participated in weekly and monthly meetings to review data findings and focus on key improvement areas.
- Collaborated on calibration sessions and additional projects as necessary to enhance operational effectiveness.
- Reviewed established policies and procedures to ensure consistent adherence across multiple departments.
- Analyzed data trends to drive actionable insights for continuous improvement initiatives.
Telephone Banking Bilingual Unit Manager I
JP Morgan Chase
San Antonio, Tx
02.2010 - 10.2011
- Supervised daily activities of 12 to 25 telephone bankers, fostering motivation and recognition for strong performance.
- Established goals and standards for individual team members to achieve collective targets.
- Implemented staff development programs to enhance skills and promote career growth.
- Analyzed statistical reports to optimize staff performance and identify improvement opportunities.
- Executed additional functions as directed by management to support operational objectives.
- Prepared and presented reports on unit performance, challenges, and achievements to senior management.
- Conducted performance reviews for all unit personnel.
Assistant Relief Unit Manager
JP Morgan Chase
San Antonio, Tx
09.2009 - 02.2010
- Supervised daily operations as Assistant Relief Unit Manager for apprentice team of 6 to 12 telephone bankers.
- Motivated team members by recognizing strong performance and establishing clear goals.
- Conducted individual counseling sessions, providing ongoing coaching and training.
- Monitored call quality and performed one-on-one reviews to ensure compliance with training standards.
- Assisted staff with escalated calls to identify, research, and resolve complex issues.
- Maintained accurate attendance records, management reports, and training documentation.
- Established and upheld policies and procedures, ensuring adherence across the team.
Email Response Banker
JP Morgan Chase
San Antonio, Tx
08.2009 - 09.2009
- Acted as primary contact via email for Personal Consumer customers in Kana Program.
- Executed complex and straightforward requests, fostering a Problem Resolution culture.
- Adapted to business needs by handling emails and overflow calls during peak periods.
Online General Telephone Banker
JP Morgan Chase
San Antonio, Tx
06.2009 - 08.2009
- Served as primary contact for Personal Consumer customers and Online Banking support.
- Facilitated online navigation and conducted password resets for account maintenance.
- Managed account transactions and resolved customer issues efficiently.
- Processed product referrals while cross-selling additional products and services.
Peer Coach
JP Morgan Chase
San Antonio, Tx
02.2009 - 06.2009
- Supervised daily activities of 2-4 new hire telephone bankers in training environment.
- Coached new hires on policies and procedures to enhance performance understanding.
- Monitored call quality and addressed questions to ensure compliance.
- Led training sessions for incoming Peer Coaches, fostering effective onboarding practices.
Education
Organizational Leadership -
Palo Alto College
San Antonio, TX01.2003
Political Science -
Our Lady of the Lake University
San Antonio, TX01.2001
High School Diploma -
Providence High School
San Antonio, TX01.1998
Skills
- Insurance policy management
- Medical claims processing and claims resolution
- Quality assurance and compliance
- Product expertise
- Excellent communication skills
- Team collaboration
- Business development
- Records maintenance and data entry
- Personal development
- Customer experience strategies
- Analytical thinking
- Software proficiency
- Solutions planning
- Adaptability and flexibility
- Staff training techniques and training facilitation
- Transaction handling
- Business operations management
- Social media marketing
Certification
- Texas Personal lines Property & Casualty License
Languages
Spanish
Professional
References
References available upon request.
Timeline
Licensed Insurance Customer Service & Sales Professional III
USAA
10.2023 - Current
Medical Claims Review Coordinator
UnitedHealth Group/Optum
08.2022 - 08.2023
MHBP Member Advocacy Center, Senior Service Advocate
Aetna
08.2019 - 08.2022
MHBP Consumer Option Senior Customer Service Representative
Aetna
07.2017 - 08.2019
MHBP Senior Customer Service Representative
Aetna
03.2017 - 07.2017
HICS Escalations Senior Health Concierge
Aetna
04.2016 - 03.2017
HICS Escalations Health Concierge
Aetna
09.2015 - 04.2016
HICS Escalations Associate Health Concierge
Aetna
11.2014 - 09.2015
Associate Health Concierge
Aetna
04.2014 - 11.2014
Quality Support and Data Analyst I
JP Morgan Chase
10.2011 - 03.2014
Telephone Banking Bilingual Unit Manager I
JP Morgan Chase
02.2010 - 10.2011
Assistant Relief Unit Manager
JP Morgan Chase
09.2009 - 02.2010
Email Response Banker
JP Morgan Chase
08.2009 - 09.2009
Online General Telephone Banker
JP Morgan Chase
06.2009 - 08.2009
Peer Coach
JP Morgan Chase
02.2009 - 06.2009
Owner
Veronica's Cakery
08.2004 - Current
Organizational Leadership -
Palo Alto College
Political Science -
Our Lady of the Lake University
High School Diploma -
Providence High School
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