Customer Service Management

ILIANA CARBAJAL

Cell 915-***-****

***** *** ******* #****~San Antonio, TX 78249

********.**@*****.***

Summary of Qualifications

Strengths include a meticulous attention to detail, exceptional customer service, outstanding

communication and listening skills, great time management and organizational skills. Skills encompass

problem solving skills, conflict management skills, and the ability to make independent decisions.

Work experience have imparted a great capability to interact, understand and relate to people from all

ranges of socioeconomic, educational and ethnic backgrounds. Knowledge of business management,

accounting, marketing, and all business related courses. Language aptitude includes English/Spanish

and proficient in all Microsoft applications

Professional Experience

Amerigroup, INC.

LTSS Case Specialist 2012 Present

San Antonio, TX

• Handle inbound calls from members and community providers, first call resolution to any

questions, problems and concerns before referring to clinical team.

• Work closely with Case Managers to coordinate health care services by facilitating, a variety

of long term care treatment and health care plans.

• Coordinate, resolve claims issues, create provider service authorizations, monitoring and

tracking of health care services.

• Assist Stabilization Case Managers with introduction calls, Performed Post hospital discharge

follow up calls for Complex cases. Scanned care plans into MACESS Computer Program.

Arcadian Health Plan (Humana Inc.)

Case Management Coordinator 2011 2012

El Paso, Texas

Actively participated and contributed to case management process including outreach to

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members under direction of clinical team.

Made outbound calls to members at the direction of the clinical team (follow up after

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discharge from hospital and performed HRA.

Assisted the clinical team with non clinical tasks associated with the performance of the case

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management process including, pre authorization, concurrent and retrospective review for all

inpatient and outpatient services as outline in the case management program

Performed duties in such a way as to insure that health plans meets CMS guidelines and

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delegation requirements for case management, utilization management, appeals & grievances,

and quality improvement.

Texas Department of Health and Human Services Commission

Eligibility Specialist III 2009 2011

Medicaid (El Paso, Texas)

Field Office (Orange, Texas)

Determined eligibility for Medicaid (CHIP) programs using automated systems in a field office

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performing face to face interviews.

Obtained, verified, and calculate average income and resources to determine client financial eligibility

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through background check, Data Broker System, and other government sensitive information.

• Processed changes to client status, overpayments, and adjusts or restore benefits by meeting datelines,

practicing organizational skills and excellent time management.

Document case records. Communicate on an intermediate level with others (internally or externally)

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to provide, exchange, or verify information, answer inquiries, address issues, or resolve problems or

complaints.

Clear Channel Communications Inc.

Account Executive/Marketing Specialist 2008 2009 El

Paso, Texas

• Managed existing accounts and create new accounts by providing excellent customer service and

discover the needs of the business to coordinate a marketing campaign.

Created effective sales presentations and marketing proposals to new and existing clients.

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Presented a variety of advertising presentations and communicated with both external and internal

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clients. Performed all related work as required.

Responsible for seeking out and creating opportunities to produce additional revenues by selling local

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advertising

Sales Independent Agent For: 2007 2011

American Family Life Assurance Company (AFLAC) Arcadian

Health Plan (Medicare Advantage Organization)

Federal Life Insurance (Mutual)

License

State of Texas Certified Nurse Assistant

State of Texas Life, Health, Accident Insurance License

Volunteer Services

Adult Literacy Tutoring Program (Assist in subjects of Math, Reading, and Writing)

University of Incarnate Word

Bachelor of Science in Business (Finance) Present

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