Customer Experience Health Plan
Resume:
ABOUT Belong to an organization that allows me to apply the knowledge acquired in my years of study, such as work experiences, including my planning and organizational skills. Be part of a work team and consolidate myself professionally in a Company where personal achievements and performance are recognized and can build on them for the benefit of both. In addition to allowing opportunities for personal and professional development.
EXPERIENCE MARSHALLS, POSTER BLVD, DAVENPORT, FL
Customer Experience Coordinator
JAN 2024- PRESENT
•Responsible for promoting highly satisfied customer experience CECs oversee a team of Associates at the Font End, ensuring the education and execution of the proper ringing sequence and the promotion of loyalty programs.
•Train and coaches Associates
•Addresses customer concerns and issues promptly, ensuring a positive customer experience.
WALMART, PRINCENTON, ORLANDO, FL
Toys, Seasonal, Garden Stocker Associate
JAN 2024- PRESENT
•Unloading inventory from suppliers, accepting packages, and checking that the correct items are received.
•Organizing and displaying products
•Stocking shelves and displays in an orderly way, making sure products are well presented, and keeping storage areas clean and secure.
•Replacing damaged items, ordering replacement merchandise, and preparing inventory for shipment.
NILDA M ABREU MENDEZ
***************@*******.***
DAVENPORT, FL
VITAL MENONITE HEALTH PLAN, SAN JUAN, PR
Grievances & Appeals Specialist
JAN. 2021– FEB. 2024
•Analyze cases with procedural denied determinations by doctors.
•Analyze, resolve Complaints, Grievances and Appeals.
•Study medical cases for discussion with Medical Reviewer
•Presentation of cases for determination by Medical Reviewer
•Creation of approved cases, coordination of procedures and issuance of Approval Letters and Payment Agreements.
•Review and Work appeals with the Office of the Patient Advocate and ASES
(Government Health Plan)
•Review and Work Providers Disputes (payments denied, contract problems etc.)
•Compliance with metrics and terms
VITAL MENONITE HEALTH PLAN, SAN JUAN, PR
Customer Services Team Lead
OCT. 2018-NOV. 2019
•Supervision of the daily operations of Service Center, and personnel.
•Level II Complaint Resolution (Handle situations of complaints and grievances)
•Work group training, schedules, daily assistance.
•Implementation, if necessary, of policies and processes with team.
•Internal monitoring of service reports
•Audit of daily process.
•Coordination of weekly meetings with team
•Guide work team to achieve goals and identify new opportunities for process improvement.
•Support in the registration retention area.
VITAL MENONITE HEALTH PLAN, SAN JUAN, PR
Customer Service II
OCT. 2018-NOV. 2019
•Attention to beneficiaries.
•Level I complaint resolution.
•Eligibility Verification
•General office matters
•Coordination with service providers
•Support for the creation of internal reports and
•Weekly and Monthly Statistics
•Exhibitions at Health Fairs
MMM HOLDINGS (MMM HEALTH PLAN), SAN JUAN, PR
Providers Services Representative
MAY. 2016 – AUG. 2017
•Service billing verification.
•Analysis of Denied Invoices
•Verification of medical credentials and contract
•Advantage Medical Plan Law Regulations
•Payment Adjustments according to CPT- ICD10
•General business & Service Coordination
FIRST MEDICAL HEALTH PLAN SAN JUAN, PR
Customer & Providers Services
OCT. 2014 – MAY 2016
•Service verification.
•Eligibility Verification and Medicaid Recertifications
•Billing verification
•Verification of dental services, medications via MC21
•Service coordination.
NILVINO FASHION CRAFT CAMP, CAGUAS, PR
Teacher, Artisans, Organizer
June 2016 – June 2023
•Enrollment structure
•Preparation of daily teaching plan
•Preparation of class materials
•Teaching crafts to students 8-16 years old
•Project Management
•Coordination of Activities
•Social Media, Planning Programs
•Supervision of Personnel imposition of standards
•Inventory
EDUCATION AGM UNIVERSITY
BA SERVICES MANAGEMENT HEALTH 2023 – NOW
HUERTAS JR COLLEGE
G.A. PARALEGAL 2006
IBC COLLEGE
RESPIRATORY THERAPY 2004
SKILLS + INTERESTS Teamwork, handling of pressure situations, good communication skills, ready for new challenges, available to new teachings, open to constructive criticism and the implementation of these, as necessary, work under little or no supervision, organized, punctual, responsible. With 5+ years of experience in designing and crafting.
Marketing, Project Management, Budget Planning Social Media, Planning, Teaching, Supervising, Microsoft Office 365, Canva, Drive, Internet, Zoom, Microsoft 365, Various Crafting Programs.
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