Andrew Garcia
Gilbert,AZ
Summary
Results-driven healthcare operations professional with over 8 years of experience in appeals, claims resolution, and customer advocacy across Medicare, Medicaid, and commercial plans. Proven expertise in managing high-volume, complex cases while ensuring compliance with state and federal regulations, resulting in significant improvements in resolution efficiency and a reduction in escalations. Recognized for supporting cross-functional teams and fostering collaboration to achieve organizational goals. Thrives in remote, fast-paced environments that demand accuracy, independence, and strong problem-solving skills.
Overview
10
10
years of professional experience
Work History
Senior Coordinator, Complaint and Appeals Operations
Aetna
10.2020 - 02.2026
- Evaluated and resolved up to 30 complex appeal cases weekly, maintaining adherence to regulatory standards and deadlines.
- Act as a Subject Matter Expert (SME) supporting a team of 10+ employees on appeals workflows and claims processes
- Conducted thorough analysis of claims eligibility and payment data to uphold high standards of accuracy.
- Interpreted plan benefits and regulatory guidelines to assess and substantiate denial decisions and appeal results.
- Guided new employees through onboarding processes and mentorship programs to accelerate team performance.
- Contribute to workflow enhancements that improved turnaround times and overall team productivity
Senior Member Service Advocate
United Healthcare
06.2018 - 06.2020
- Resolved intricate Medicare and Medicaid member issues through effective handling of 25-30 inbound and escalated calls each day.
- Implemented strategies to achieve a first-call resolution rate exceeding 90%, thereby reducing repeat inquiries and boosting member satisfaction.
- Maintained top-tier performance metrics in call quality, efficiency, and adherence
- Developed and implemented educational materials on claims authorizations and appeals, fostering improved understanding among members.
Senior Retention Subject Matter Expert
Centurylink
08.2016 - 11.2017
- Managed high-volume customer accounts (40–60 daily interactions) across billing, service, and retention
- Ranked #1 in regional sales performance (Q3) for retention and add-on services
- Improved customer retention by offering tailored solutions and resolving service concerns
- Coordinated technician dispatch and service requests, ensuring timely installations and issue resolution
- Provided technical troubleshooting and account support, reducing escalations
Education
Associate of Science - Culinary Arts Operations
Auguste Escoffier School of Culinary Arts
Boulder, CO08.2026
High School Diploma -
Desert Ridge High School
Mesa, AZSkills
- Proposal writing
- Meeting facilitation
- Project assistance
- Discretion and confidentiality
- Attention to detail
- Verbal and written communication
Timeline
Senior Coordinator, Complaint and Appeals Operations
Aetna
10.2020 - 02.2026
Senior Member Service Advocate
United Healthcare
06.2018 - 06.2020
Senior Retention Subject Matter Expert
Centurylink
08.2016 - 11.2017
Associate of Science - Culinary Arts Operations
Auguste Escoffier School of Culinary Arts
High School Diploma -
Desert Ridge High School
AWARDS AND ACKNOWLEDGEMENTS
Established a reputation as a trusted and dependable contributor, regularly qualifying for quarterly performance bonuses and incentives. Recognized for maintaining high standards of accuracy, productivity, and consistency while supporting team success.