VICTORIA RAYAS

Company Overview: a VSP Vision Company (Health Plan)

• Managed a portfolio of Medicare and Medicaid health plan customers for an eyecare insurance company, responsible for building the state of Texas territory strategy, managing relationships with key accounts, developing a pipeline of new business with existing accounts and prospects, forecasting sales, and achieving performance goals.
• Engaged with national client accounts on opportunities, training, and programs, leveraging strong in-person and remote sales techniques to communicate, educate, persuade, and secure sales.
• Developed the territory strategy in alignment with broader internal corporate objectives and senior leadership, building the business plan and partner account strategies to achieve sales quotas, and collaborating with the sales team to identify and grow opportunities within the territory.
• Cultivated a network of customers, prospects, and partners, including Medicaid and Medicare stakeholders, fostering long-term relationships and gaining a keen understanding of their decision-making process.
• Drafting monthly performance reports for the executive team to highlight both high-performing and underperforming accounts, and to present during JOC meetings and ad-hoc meetings.
• Travel to client meetings, conferences, tradeshows, and other events.

• Company Overview: Health Plan
• Oversaw the design, implementation, and performance of quality and member direct programs for the Fortune 500 health insurance company, analyzing data in alignment with Healthcare Effectiveness Data and Information Set (HEDIS), corporate objectives, and regulatory standards.
• Managed a provider relations team, fostering professional growth, enhancing performance, and optimizing collaboration within the team.
• Managed client national accounts and actively marketed services to healthcare vendors under contract, ensuring adherence to the Statement of Work (SOW).
• Deliver proactive data analytics to uncover, monitor, measure, and showcase member business trends, and contract opportunities.
• Through personalized interactions and detailed reports, empower members to make informed, timely decisions.
• Engage in face-to-face consultations with medical providers and healthcare staff to evaluate STARS performance KPI metrics and affirm contentment, adhering to established client engagement protocols and success benchmarks.
• Assist with regional quality programs, and perform analysis on Medicare plan membership to determine applicable educational outreach and approach.
• Developed regular dashboards on key performance indicators, and quality KPI metrics, to facilitate informed discussions and actions to drive continuous quality improvement.

NETWORK PROGRAM MANAGER

• Managed relationships with HCPs (Health Care Providers) across El Paso, West Texas, and New Mexico territory delivering tailored recommendations and promote products and services while strategically expanding the network to meet service demands
• Consulted medical providers and staff to clarify missing or inadequate patient information to determine appropriate diagnostic and procedure codes for, focusing on chronic conditions utilizing data
• Consistently meeting annual and quarterly objectives for medical provider engagement, program implementation, and cost metrics, and employing analytics to deliver performance reports (KPI metrics) at regional and market levels to executive management.
• Facilitating the setup, implementation, education, and training for providers and facilities on the population health platform.
• Instrumental in market expansion strategies, consulting with medical providers, conducting thorough research, and resolving issues related to claims, forms processing, medical coding, and reimbursement.
• Negotiated favorable contracts with local pharmacy companies, securing significant cost savings for members.
• Collaborated with healthcare providers to optimize drug utilization and cost-effectiveness, resulting in the successful closure of care gaps, and enhancing patient outcomes.

• Actively promoting and selling diagnostic imaging products and services, while strategically expanding the network to meet growing service demands.
• Initiating a new business by engaging in cold calling, referrals, and generating leads to uncover fresh business prospects.
• Collaborated with internal stakeholders to include radiologists, and implemented strategic plans to increase market penetration for specialty imaging services, cultivating strong relationships with medical providers and radiologists that enabled a consistent pipeline for growth.
• Orchestrated and executed strategic marketing events and trade shows, showcasing service benefits to medical providers and the community.
• Organized and led a successful marketing blitz, coordinating efforts and strategies within the team to achieve targeted goals.
• Analyze consumer behavior data to identify trends and optimize marketing strategies.

• Collaborated with medical providers to identify targets, pursue leads, and communicate with prospects about the most effective medical programs, resulting in a significant increase in the client base and consistently meeting monthly goals.
• Implemented comprehensive sales strategies and marketing plans to consistently exceed sales targets through direct interactions, including in-office visits, in-service presentations, and speaker programs.
• Analyze consumer behavior data to identify trends and optimize marketing strategies
• Initiating a new business by engaging in cold calling, referrals, and generating leads to uncover fresh business prospects.
• Consistently achieves the company's annual and monthly goals for provider engagement, program adoption, and cost metrics, utilizing analytics to present performance reports on both regional and market levels to executive management.