Summary
Overview
Work History
Education
Skills
Timeline
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Yoenia De La Fuente

Summary

Seeking a challenging and rewarding opportunity that offers personal and professional growth within a stable and progressive organization.

Overview

11
11
years of professional experience

Work History

Advocate4Me Sr Rep

United Healthcare
06.2022 - Current
  • Resolved issues through careful research and follow-up with a panel of 700+ Florida members.
  • Coordinate gaps of care and provide white glove service
  • Trained/Mentored newly hired employees on company policies and procedures regarding diverse situations.
  • Assist on Inbound calls as necessary
  • Assure all MAP/QVC goals are met to exceed as a top performer
  • Assist the team with any questions and be a source of support as needed
  • Assist in Coaching opportunities with UES/Compliance Cases
  • Presented refreshers to the team as requested to ensure the correct operational process was understood and followed
  • Answered questions quickly via email or return phone call within 48 hour period

Grievance & Appeals Supervisor

Humana/CarePlus
10.2020 - 03.2022
  • Setting goals for performance and deadlines in ways that comply with company’s plans and vision
  • Organizing workflow and ensuring that employees understand their duties or delegated tasks
  • Monitoring employee productivity and providing constructive feedback and coaching
  • Oversee a team of 19+ Grievance and Appeals representatives
  • Head of CTM team, directly overseeing cases received and updates submitted
  • Plan, Prioritize, organize and complete work to meet established objectives
  • Develop strategies/action plans for better performance
  • Handle Escalated issues & Supervisor calls
  • Develop training manuals & Job aids

Team Lead

UnitedHealthCare South Florida
05.2016 - 10.2020
  • Commitment Champ for the SFL site
  • Work with each advocate on a daily basis to assure commitments are being closed before the 48 HRS mark
  • If unable to resolve issue report reasoning why the commitment has not been resolved
  • Review all Grievances/QOC/CD/OD before advocates submit
  • Coach each advocates on QA, Compliance, Adherence, and all Metrics
  • Supervisor calls
  • Overview the SFL site’s adherence and do callouts by team
  • Handle DMR’s for member walk ins, emails and mail
  • Send personally to get processed and keep communication with the member regarding status
  • Audit calls for the month as needed
  • Applies knowledge/skills to complex activities
  • Demonstrates a depth and breadth of knowledge/skills in own area and is often able to apply these outside of own function
  • Often acts as a technical resource to others in own function
  • Anticipates customer needs and proactively identifies solutions
  • Solves complex problems on own; proactively identifies new solutions to problems
  • Plans, prioritizes, organizes and completes work to meet established objectives
  • Acts as a facilitator to resolve conflicts on team; seen as key team member on project teams spanning more than own function
  • Identify and communicate steps/solutions to caller questions/issues, using appropriate problem-solving skills and established guidelines, where available (e.g., workarounds, descriptions of relevant processes)
  • Make outbound calls to resolve caller questions/issues (e.g., to callers, providers, brokers, pharmacies)
  • Drive resolution of caller questions/issues on the first call whenever possible (e.g., first-call resolution, one-and-done)
  • Ensure proper documentation of caller questions/issues (e.g., research conducted, steps required, final resolution)

Accounts Payable/Accounting Assistant

Palmetto General Hospital
06.2012 - 01.2016
  • Processing and obtaining proper authorization for all the invoices that come in through the hospital
  • Verifying daily cashier deposits
  • Journal Entries and Balance sheet processing
  • Creating Purchase Orders when needed to expedite payments
  • Obtaining Payments for hospital invoice

Education

High School Diploma -

Hialeah High School

Skills

  • Self-management skills/Time Management
  • Leadership
  • Communication
  • Leading Training Opportunities
  • Team-Building Exercises
  • Microsoft PowerPoint/Word/Excel
  • Adaptability to change

Timeline

Advocate4Me Sr Rep

United Healthcare
06.2022 - Current

Grievance & Appeals Supervisor

Humana/CarePlus
10.2020 - 03.2022

Team Lead

UnitedHealthCare South Florida
05.2016 - 10.2020

Accounts Payable/Accounting Assistant

Palmetto General Hospital
06.2012 - 01.2016

High School Diploma -

Hialeah High School

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Yoenia De La Fuente