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, NY06.1998
High School Diploma -
Cristoza Colon High School
Dominican Republic03.1995
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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