Visalia, California, United States
With two decades of experience in healthcare, insurance, and customer service, I oversee operations at United Health Centers' South Valley Clinics, including locations in Delano, Visalia, Huron, and Lemoore. My work is grounded in a commitment to enhancing the quality of care, supported by expertise in quality assurance, risk management, and time management. My career has focused on leading high-impact teams and optimizing processes in claims processing, call centers, referral centers, and health center operations. Leveraging Lean Six Sigma methodologies, I contribute to measuring and improving operational success, ensuring patient-centered care remains at the forefront of every initiative.
•Own the client experience across the end-to-end process for new and renewing clients. •Present implementation plans to clients, brokers and Sales and work with Sales and client to obtain critical information necessary for account set-up. •Lead implementation meetings with client (may be in-person meetings) and develop and present implementation calendar to client including matrix partner deliverables. •Act as a benefits expert and interact with client on benefit intent. •Partner with Matrix Partners to assess the feasibility of requested plan designs and understand and execute on client’s plan interpretation and Cigna's service administration capabilities. •Surface, negotiate and resolve all issues relative to implementation, process, plan design and timing of deliverables. •Communicate outcome and next steps with Sales, Client Service Executive and other matrix partners as needed.
• Managed the accurate and timely adjudication of claims and administered dispostion according to contractual benefits and company procedures. •Created high impact teams to overachieve client expectations and consistently decreased claim volumes. •Continuously improved processes in order to minimize bottlenecks and created efficient workflows to ensure timelines were met. •Provided direction and guidance regarding policies, procedures, workflows, claim service quality, and training needs. •Responsible for monitoring and overachieving claim service standards, as well as minimizing costs at all times. •Managed multiple performance guarantee accounts, ensuring that metrics were met to minimize financial payout and exceeded client expectations. Continuously kept financial accuracy above 99.3%. •Participated in client presentations to review site operations and answer service questions regarding hiring and training of staff, roles of responsibilities of functional areas etc.