Diego Tobon

Healthcare professional with experience in care coordination, patient education, insurance navigation, and clinical documentation. Skilled in authorizations, claims assistance, and Provider-patient relations. Adept at managing appointments, coordinating transportation, and supporting high-risk patients. Committed to providing patient-centered care and improving operational efficiency in healthcare settings.

Benefit Specialist III at Elevance Health (2023-09 – Present)

• Explained medical, pharmacy, and behavioral health benefits to members in English and Spanish.
• Assisted with claims review, status updates, and coverage verification.
• Processed and tracked prior authorizations for procedures, imaging, and specialist care.
• Coordinated appointments and arranged transportation for patients.
• Communicated with providers to obtain clinical documentation and referrals.
• Educated patients on plan coverage, costs, and care pathways.
• Documented all interactions accurately in case management systems.
• Liaised with physician office financial departments to identify and resolve claims errors, including CPT coding issues and provider ID discrepancies

Nurse Case Coordinator at United Healthcare (2022-07 – 2023-08)

• Coordinated patient care plans with physicians and interdisciplinary teams.
• Conducted preoperative risk assessments and ongoing clinical evaluations.
• Collected and analyzed patient health data to identify care needs.
• Educated patients and caregivers on treatments, recovery, and follow-ups.
• Facilitated communication between hospitals, PCPs, and specialists.
• Maintained accurate EMR documentation including medications, treatments, and discharge instructions.

Floor Supervisor at Louis Vuitton (LVMH) (2018-05 – 2021-07)

• Evaluated work of +100 floor employees to improve performance.
• Maintain established merchandising standards, including window, sales floor and promotional displays.
• Met with management to discuss work plans and develop enhancements.
• Coached employees and trained methods for handling various aspects of sales, complicated issues, and difficult customers.
• Reduced employee turnover with hands-on leadership and coaching
• Held 10-minute team meetings in the morning to gain feedback, provide updates and remind
• Trained team members in successful strategies for meeting operational and sales targets.
• Established and optimized schedules to keep coverage and service in line with forecasted demands.
• Completed all daily tasks and special assignments with an efficient and quality-driven approach.

Associate Degree in Nursing in Nursing – Miami-Dade College (2020 – 2022)

High School Diploma – American Senior High (2012 – 2016)