ILEANA MOLINA
Florissant
Summary
Dynamic professional with extensive experience in customer service, community outreach, and member retention. Skilled in fostering relationships with community members, providers, and partners to achieve membership and enrollment goals. Proven ability to manage health fairs, outreach events, and training sessions while meeting and exceeding performance metrics. Adept at navigating regulatory requirements and utilizing technology to optimize outreach and member services.
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
10
10
years of professional experience
Work History
Customer Service Advocate I
Centene: Ambetter Health
Remote, MO
03.2024 - Current
- Responded to all routine member inquiries and/or concerns from both new and existing members in timely and accurate manner.
- Met daily production metrics and quarterly goals for quality calls
- Provided member resolution by researching, analyzing and documenting their inquiries regarding claims, authorizations, and account details.
- Mitigated and prevented complaints from being escalated to resolve in initial contact
- Front line resolution advocate on various inquiries and concerns
- Conducted follow up calls to pending inquiries and served as a liaison between the member and our different Ambetter departments
- Conducted a needs based analysis to better understand the best course of action based on those needs and answered benefit questions and provider network questions for members both within and outside of my region
- Documented all interactions in the CRM system, Omni
- Input, updated and created member information on databases in order to maintain customer accounts current
- Followed organization standards to maintain excellent quality service.
- Performed tasks in accordance with all regulatory, audit and corporate policies to meet compliance requirements
Customer Service Advocate
Vision Service Plan “VSP”
Remote, MO
09.2023 - 01.2024
- Responded to all routine member inquiries and/or concerns from both new and existing members in timely and accurate manner.
- Met daily production metrics and quarterly goals for quality calls
- Managed large high call volume 90-100 calls daily
- Provided member resolution by researching, analyzing and documenting their inquiries regarding claims, authorizations, and account details.
- Front line resolution advocate on various inquiries and concerns
- Mitigated and prevented complaints from being escalated to resolve in initial contact
- Conducted follow up calls to pending inquiries and served as a liaison between the member and the different VSP departments
- Conducted a needs based analysis to better understand the best course of action based on those needs and answered benefit questions and provider network questions for members both within and outside of my region
- Documented all interactions in the CRM system, Salesforce
- Input, updated and created member information on databases in order to maintain customer accounts current
- Followed organization standards to maintain excellent quality service.
- Performed tasks in accordance with all regulatory, audit and corporate policies to meet compliance requirements
Retention Field Specialist
Centene Fidelis Care
New York, N.Y
03.2022 - 09.2023
- Responsible for retaining current membership by assisting members with the completion and processing of Government health program applications
- Responded to all inquiries regarding the application process from both new and existing members
- Met daily production metrics and quarterly goals for retained memberships
- Provided member resolution by researching, analyzing and documenting their inquiries regarding program eligibility
- Conducted outreach and follow up calls to educate members about Fidelis Products and served as a liaison between the member and our different Fidelis departments
- Conducted a needs based analysis to better understand the best course of action based on those needs and answered product feature and benefit questions and provider network questions for members both within and outside of my region
- Documented all interactions in the appropriate system (Sales Force, Facets) including marketing leads
- Input, updated and created member information on databases in order to maintain customer accounts current
- Followed organization standards to maintain excellent quality service.
- Performed tasks in accordance with all regulatory, audit and corporate policies to meet compliance requirements
- Conducted telephonic and field outreach which included assisting at community events, provider and community office sites to new and existing members
- Scouted community event, provider office for further outreaching, increasing health insurance availability
- Mentored New hires: training new team members in phone call protocols, application process and documenting all inquiries in salesforce and facets.
Medical Receptionist
61st Service Corporation (NYP/Allen Hospital)
New York, N.Y
03.2016 - 04.2021
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity Delivered top-notch administrative support to office staff, promoting excellence in office operations.
- Created and updated physical records and digital files to maintain current, accurate and compliant documentation.
- Provided clerical support to department employees by copying, faxing and filing documents.
- Sorted, opened and routed incoming correspondence and deliveries to help senior leaders respond quickly to business requirements.
- Greeted incoming patients professionally and provided friendly, knowledgeable assistance.
- Kept reception and Exam areas clean and neat to give visitors positive first impression.
- Communicated with patients via phone and email to confirm appointments and respond to inquiries.
- Answered large volume of incoming calls, over 30 daily to resolve patient issues and/or schedule appointments.
- Ensure prior authorizations are in place for office appointments, radiology and surgery procedures, according to Managed Care guidelines.
- Ensure that all patient visits have billing documentation that is to be submitted to billing department, including but not limited to all relevant and accurate patient demographic and insurance information.
- Follow cash management Columbia Doctors guidelines to collect TOS payments and outstanding balances prior to patient visit, create daily TOS Cash/Check logs, prepare patient receipts, make deposits and reconcile against daily schedule.
- Processed payments for providers renewals of licenses, required workshops, and registrations to conferences.
- Demonstrated respect, friendliness and willingness to help whenever needed.
Education
Certificate - Omni Channel Management
Fashion Institute of Technology New York
New York, N.YBachelor of Arts - Art Studio
City College of New York
New York, N.YAssociates in Applied Science - Electronic Media
Bronx Community College
Bronx, N.YSkills
- Data collection
- Computer proficiency
- Administrative support
- Call center experience
- Complaint resolution
- Technical support
- CRM software
- Client relations
- Office management software: Microsoft Word, Microsoft Excel
- Customer service skills: Empathy, adaptability, able to take responsibility, patience, attentive
- Omni-channel certification: creating seamless shopping experience across multiple channels
- Knowledge of optical & surgical Medical Billing and Coding
- Community outreach and event planning
Accomplishments
- Achieved 100% November World Class survey scores by delivering accurate, efficient, and empathetic service.
- Consistently met and exceeded quarterly retention goals through innovative outreach strategies.
- Successfully trained and mentored new hires to enhance team performance and ensure compliance.
Languages
Spanish
Native or Bilingual
Timeline
Customer Service Advocate I
Centene: Ambetter Health
03.2024 - Current
Customer Service Advocate
Vision Service Plan “VSP”
09.2023 - 01.2024
Retention Field Specialist
Centene Fidelis Care
03.2022 - 09.2023
Medical Receptionist
61st Service Corporation (NYP/Allen Hospital)
03.2016 - 04.2021
Bachelor of Arts - Art Studio
City College of New York
Associates in Applied Science - Electronic Media
Bronx Community College
Certificate - Omni Channel Management
Fashion Institute of Technology New York