Summary
Overview
Work History
Education
Skills
Timeline
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Amber Jimenez

Summary

Knowledgeable Customer Service Representative with robust background in effectively managing and resolving grievances. Skilled in facilitating communication between parties and ensuring compliance with company policies. Demonstrated expertise in conflict resolution and documentation management.

Overview

8
8
years of professional experience

Work History

Sr. Grievance Coordinator

Centene Corporation
01.2018 - 12.2021
  • Handled an average of 25 complaints per week, ensuring compliance with corporate performance standards and guidelines
  • Enhanced customer satisfaction through empathetic communication and active listening techniques
  • Improved problem-solving efficiency through structured data gathering with Appeals, Claims, Provider Relations, and Pharmacy teams
  • Demonstrated accountability by driving a 25% increase in productivity, exceeding all established performance metrics
  • Streamlined communication efforts, resulting in a reduction in delays and strengthened relationships with other departments
  • Developed comprehensive training materials for new and existing hires on Medicare and Medicaid processes, resulting in improved onboarding efficiency

Operations Lead

WellCare Health Plans
12.2016 - 12.2017
  • Oversaw daily operations of the Member Engagement Team (MET), improving workflow and quality standards
  • Increased team morale by implementing weekly 'Food for Thought' meetings, leading to a 20% boost in team and member satisfaction

Sr. Grievance Coordinator

WellCare Health Plans
03.2015 - 12.2016
  • Address member complaints through written correspondence, adhering to corporate guidelines and performance standards
  • Achieved a Quality Audit (QA) score of 97% or higher while surpassing production metrics
  • Partnered with Appeals, Claims, Provider Relations, and Pharmacy departments to gather data and resolve complaints effectively

Care Gap Coordinator

WellCare Health Plans
03.2014 - 03.2015
  • Reached out to over 300 members via telephone to promote preventive health screenings, addressing barriers to care and scheduling appointments for 95% of them
  • Coordinated transportation for members as needed and maintained documentation to meet department goals

Education

Community College -

Valencia Community College
Orlando, FL
06-2003

High School -

Sickles High School
Tampa, FL
05-2000

Skills

  • Conflict resolution
  • Empathy in communication
  • Policy adherence
  • Team collaboration
  • Confidentiality maintenance
  • Emotional intelligence
  • Attention to detail
  • Service excellence
  • Organizational skills
  • Active listening
  • Task prioritization
  • Self motivation
  • Time management abilities
  • Cultural awareness
  • Complaint handling

Timeline

Sr. Grievance Coordinator

Centene Corporation
01.2018 - 12.2021

Operations Lead

WellCare Health Plans
12.2016 - 12.2017

Sr. Grievance Coordinator

WellCare Health Plans
03.2015 - 12.2016

Care Gap Coordinator

WellCare Health Plans
03.2014 - 03.2015

Community College -

Valencia Community College

High School -

Sickles High School

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Amber Jimenez