Summary
Overview
Work History
Education
Skills
Systems And Tools
Languages
References
Timeline
Generic

Clara Guerrero

Gastonia

Summary

Transformational leader with over 8 years of experience in pharmaceutical operations and patient access. Expertise in managing large-scale initiatives and implementing scalable solutions to enhance operational excellence. Bilingual executive skilled in compliance and systems optimization, known for driving measurable results through high-performing teams. Proven track record in strategic planning, risk management, and effective stakeholder communication.

Overview

17
17
years of professional experience

Work History

Interim Program Manager

Lash Group
03.2023 - Current
  • Directed team productivity, coaching, and performance improvement initiatives, resolving performance concerns and ensuring alignment with organizational goals.
  • Designed and delivered training programs, onboarding processes, and resource tools to improve team readiness and reduce onboarding time by 25%.
  • Conducted audits of critically missed elements and low-scoring calls, providing real-time feedback and performance documentation to drive quality improvement.
  • Administered program policies and procedures, ensuring adherence to compliance standards and operational excellence.
  • Served as a project subject matter expert (SME), overseeing the execution of strategic initiatives and providing guidance on process enhancements.
  • Led cross-functional teams to implement strategic initiatives and improve program efficiency.
  • Developed and maintained project plans to ensure timely completion of deliverables.
  • Coordinated stakeholder meetings to gather input and align on project objectives.
  • Analyzed program performance data to identify trends and recommend improvements.
  • Facilitated training sessions for team members on best practices and processes.
  • Streamlined communication protocols among departments to enhance collaboration efforts.
  • Developed project plans, identified risks, set objectives and monitored progress towards completion.
  • Conducted regular meetings with team members to review progress and address any issues or concerns arising from the program execution process.
  • Communicated regularly with external partners to ensure alignment of strategies and goals.
  • Provided guidance and support to team members in order to achieve targets within defined deadlines.
  • Prioritized tasks and managed teams throughout multiple projects.
  • Generated and delivered reports, program review presentations and other program status updates.
  • Collaborated with teams across departments to develop effective strategies for executing programs.
  • Coordinated with internal stakeholders to ensure successful implementation of the program initiatives.
  • Collaborated with functional managers to develop program resource plans and assign program resources.
  • Assisted in developing training materials for new hires involved in the program activities.
  • Monitored performance metrics to ensure timely completion of tasks.
  • Assessed program performance against key performance indicators (KPIs) and objectives, making data-driven decisions to guide strategic direction.
  • Facilitated change management processes, supporting the organization and stakeholders through program transitions.
  • Oversaw the resolution of issues and challenges impacting program delivery, facilitating problem-solving and decision-making processes.
  • Implemented best practices in order to maximize efficiency of operations.
  • Utilized project management tools and methodologies to track program progress, identify variances, and implement corrective actions as necessary.
  • Delegated work to staff, setting priorities and goals.
  • Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
  • Remained calm and professional in stressful circumstances and effectively diffused tense situations.
  • Reviewed completed work to verify consistency, quality, and conformance.
  • Reviewed employee performance and provided ongoing feedback and coaching to drive performance improvement.
  • Resolved customer inquiries and complaints requiring management-level escalation.
  • Evaluated individual and team business performance and identified opportunities for improvement.
  • Mediated conflicts between employees and facilitated effective resolutions to disputes.
  • Assigned work and monitored performance of project personnel.

Annual Reverification Support Associate Liaison

Lash Group
08.2022 - 03.2024
  • Trained case workers on renewal processes while managing productivity tracking, escalation queues, and feedback tools to improve team efficiency.
  • Scheduled and facilitated coaching sessions, reviewed cases for accuracy, and conducted case cleanup to ensure SLA adherence and audit readiness.
  • Created and delivered training guides, including the Med D AR24 Training Deck, FPL Change Guide, and Prior Authorization Status Follow-Up Guide, enhancing program knowledge.
  • Designed and implemented creative training tools, such as the AR24 Jeopardy game, to engage and educate team members.
  • Collaborated cross-functionally to assign cases, streamline workflows, and improve case handling accuracy and speed.
  • Collaborated with team members to enhance service delivery processes.
  • Utilized CRM software to track and manage customer interactions.
  • Provided training support to new associates on company procedures.
  • Participated in team meetings to discuss service improvements and updates.
  • Responded promptly to escalated issues, ensuring timely resolutions for customers.
  • Investigated complex problems and identified appropriate solutions.
  • Managed online help desk tickets from creation to resolution.
  • Implemented changes as needed based upon feedback from customers or management team members.
  • Assisted in testing new products prior to launch in order to identify any potential issues.
  • Created detailed reports of all customer service activities.
  • Trained new employees on the use of internal software applications.
  • Developed processes for resolving customer service issues quickly and efficiently.
  • Ensured compliance with company policies and procedures related to customer service.
  • Analyzed data trends to improve overall effectiveness of the support team.
  • Evaluated documents to check for accuracy and note missing information.
  • Resolved customer complaints promptly and professionally.
  • Collaborated with other departments to ensure timely resolution of customer issues.
  • Reviewed incoming requests for support services and prioritized accordingly.
  • Performed quality assurance reviews on completed work orders prior to submission for approval.
  • Monitored performance levels of computer systems to identify any potential problems.
  • Consulted via telephone to understand user problems, run through testing scripts and ask probing questions to locate root causes.
  • Documented repair processes and helped streamline procedures for future technical support actions.
  • Maintained up-to-date knowledge of software and technical developments through reading and training.
  • Utilized enterprise desktop management tools to remotely assist others and deploy software.
  • Enhanced productivity and customer service levels by anticipating needs and delivering outstanding support.
  • Coordinated with internal teams to ensure timely and successful delivery of solutions according to client needs.
  • Facilitated communication between patients and healthcare providers effectively.
  • Supported team meetings by preparing agendas and summarizing discussions thoroughly.

Reimbursement Appeal Specialist / Team Lead

Lash Group
11.2020 - 09.2023
  • Reviewed pre-authorization denial letters to develop appeal strategies, ensuring timely and accurate submissions for providers and patients.
  • Led reimbursement appeal team initiatives, providing guidance, assignment distribution, and training to improve team capabilities.
  • Communicated with clients to gather necessary documentation for appeals.
  • Analyzed case files to ensure compliance with regulatory standards.
  • Collaborated with cross-functional teams to resolve complex appeal cases.
  • Maintained accurate records of all appeal submissions and outcomes.
  • Assisted in training new staff on appeals processing procedures.
  • Conducted follow-ups on pending appeals to expedite resolution.
  • Utilized case management software to track appeal progress efficiently.
  • Advised customers on best practices for submitting complete documentation along with their appeal requests.
  • Analyzed medical records to determine if further information was needed in order to process appeals.
  • Demonstrated ability to work independently as well as collaboratively within a team environment.
  • Collaborated with provider relations staff to resolve disputes between providers and health plans concerning payment for services rendered.
  • Ensured all documents are stored securely according to HIPAA standards.
  • Demonstrated strong problem solving skills when resolving difficult customer service issues.
  • Researched complex cases involving multiple parties or multiple issues to provide accurate decisions on appeals.
  • Identified trends in the types of appeals received, and reported those findings to management.
  • Responded promptly and professionally to customer inquiries via phone, email or fax.
  • Worked closely with internal teams such as Medical Directors, Customer Service Representatives, and Provider Relations staff in order to facilitate successful resolution of appealed claims.
  • Participated in training sessions on new rules or regulations affecting the appeals process.
  • Maintained up-to-date knowledge of applicable laws, regulations, policies and procedures related to appeals processing.

Case Manager / Patient Access Specialist (Bilingual)

Lash Group
03.2017 - 11.2020
  • Delivered advanced services to patients, providers, and caregivers, including benefits investigations, prior authorizations, and financial assistance application facilitation.
  • Provided bilingual support for claims assistance, benefit verification, welcome calls, alternate coverage research, and appeals processing, ensuring equitable access for Spanish-speaking patients.
  • Collaborated with the field team to resolve complex patient access challenges, improving care continuity and patient satisfaction.
  • Coordinated communication between clients and healthcare providers.
  • Documented case notes and maintained accurate client records.

IBO Services eCare Agent & Field Support Services Agent

ACN Inc
Concord
07.2008 - 03.2017
  • Delivered high-volume customer service via chat and phone, maintaining QA scores above 90% while efficiently resolving issues.
  • Provided business tool support, compensation reviews, and troubleshooting for field representatives to improve operational effectiveness.
  • Assisted representatives in managing their businesses by conducting research, resolving customer issues, and ensuring accurate compensation processes.
  • Responded promptly to customer inquiries and complaints in a professional manner.
  • Delivered excellent service via inbound and outbound calling efforts, meeting established minimum targets.
  • Completed research to thoroughly understand client requirements.
  • Evaluated and identified opportunities to drive process improvements, positively impacting customer experience.
  • Utilized computer systems for tracking, information gathering and and or troubleshooting.
  • Led training sessions for junior agents to enhance team capabilities.
  • Conducted due diligence on behalf of clients for various transactions.
  • Facilitated communication between parties to ensure mutual understanding and agreement.

IBO Services SPOC Analyst

ACN Inc
07.2008 - 03.2017
  • Supervised case assignments, ensuring SLA compliance and timely resolution of escalated issues.
  • Trained and onboarded new hires, delivering system updates and operational resources to improve team readiness and performance.
  • Monitored and reported call drivers and repeat caller data, providing actionable insights to leadership for strategic decision-making.

Education

GED -

Evander Child High School
Bronx, NY
06.1998

High School Diploma -

Cristoza Colon High School
Dominican Republic
03.1995

Skills

  • Strategic leadership
  • Program management
  • Cross-functional collaboration
  • Stakeholder engagement
  • Pharmaceutical operations
  • Compliance adherence
  • Workforce management
  • Team development
  • Process improvement
  • Patient access services
  • Financial assistance programs
  • Data analysis and reporting
  • Bilingual communication
  • CenterX proficiency
  • Pharmacy benefit portals expertise
  • Salesforce iCare knowledge
  • MedConnect familiarity
  • Calabrio usage
  • Microsoft 365 applications
  • Azure cloud services
  • CRM tools proficiency
  • Citrix experience
  • Avaya systems knowledge
  • Performance and training development
  • Customer relationship management strategies
  • Risk identification and problem solving techniques
  • Conflict resolution skills
  • Effective communication abilities
  • Leadership development initiatives
  • Time management expertise
  • Training development
  • KPI tracking
  • Project coordination
  • Team leadership
  • Onboarding and training
  • Flexible and adaptable
  • Quality assurance evaluation
  • Detail-oriented
  • Customer service
  • Utilization management
  • Good judgment
  • Project management
  • Effective negotiations

Systems And Tools

  • CenterX
  • Pharmacy Benefit Portals
  • Salesforce iCare
  • PatientPlus
  • Calabrio One
  • Team member powerBI
  • Sharepoint
  • MedConnect
  • Calabrio
  • Microsoft 365 (Excel, PowerPoint, SharePoint)
  • Azure
  • CRM Tools
  • Citrix
  • Avaya

Languages

English
Professional
Spanish
Professional

References

References available upon request.

Timeline

Interim Program Manager

Lash Group
03.2023 - Current

Annual Reverification Support Associate Liaison

Lash Group
08.2022 - 03.2024

Reimbursement Appeal Specialist / Team Lead

Lash Group
11.2020 - 09.2023

Case Manager / Patient Access Specialist (Bilingual)

Lash Group
03.2017 - 11.2020

IBO Services eCare Agent & Field Support Services Agent

ACN Inc
07.2008 - 03.2017

IBO Services SPOC Analyst

ACN Inc
07.2008 - 03.2017

GED -

Evander Child High School

High School Diploma -

Cristoza Colon High School

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Clara Guerrero