Angelique Robles
Mesa,AZ
Summary
Results-driven professional with experience in case management, project coordination, client relations, and business operations. Skilled in managing complex cases, working independently, balancing competing priorities, navigating diverse systems, and addressing client and organizational needs. Strong abilities in decision-making, time management, documentation, problem-solving, and communication. Known for producing thorough, accurate, high-quality work while maintaining efficiency and professionalism in fast-paced environments.
Overview
13
13
years of professional experience
Work History
Patient Assistance Counselor
AbbVie via Spectraforce Technologies Inc. (Remote)
Chicago, Illinois
02.2025 - Current
- Conduct comprehensive insurance coverage investigations across Medicare, Medicaid, commercial, and other payer plans by performing payer outreach and leveraging insurance intelligence and web-based tools to verify patient eligibility and benefits
- Review and evaluate financial documentation for completeness and accuracy to support eligibility determinations for applicable assistance programs
- Provide subject matter expertise on medical and prescription insurance coverage, medication prior authorization processes, and alternative financial assistance opportunities available to patients
- Apply AbbVie Patient Assistance Program standards to each case to determine eligibility and render appropriate approval or denial decisions
- Conduct outreach to obtain missing information required to complete application assessments
- Maintain accurate documentation of all patient cases within the Customer Relationship Management (CRM) system, ensuring compliance with established business rules, policies, and procedures
- Receive and manage incoming calls from patients and physician offices, providing timely assistance and support as needed
- Complete renewal and year end recertification’s process as determined by the AbbVie Patient Assistance Program
- Support special projects within the scope of the role, as requested by management, to identify opportunities for improved reimbursement optimization
Care Guide
Oscar Health Insurance
Tempe, Arizona
10.2018 - 08.2021
- Routine inbound calls and secure messages assisting insurance members with medical claims, eligibility, billing, prescriptions, prior authorizations, benefits, coverage, technical issues, provider network issues, and care resources
- Escalate member situations to the appropriate department per the member’s issues/requests
- Outbound call projects, outbound calls in general when member follow up is necessary via phone due to inquiries and/or escalations
- Escalate knowledge management tickets to ensure content is up to date and accurate for member services
- Work as a “Training Lab Coach” to assist with new hire training classes
- Assist the concierge team with content questions and resources to content
- Collaborate across departments for member resolution
Complaints, Grievances, and Appeals Liaison
Oscar Health Insurance
Tempe, Arizona
08.2021 - 10.2024
- Work assigned Commercial grievances regarding medical claims, eligibility, billing, prescriptions, prior authorizations, benefits, coverage, technical issues, provider network issues, and care resources based on rotation, of 25 cases per week
- Work assigned Commercial and Medicare grievances regarding medical claims, eligibility, billing, prescriptions, prior authorizations, benefits, coverage, technical issues, provider network issues, and care resources based on rotation, of 25 cases per week
- Perform initial analysis of cases to determine next steps and/or escalation pathway(s)
- Perform, complete, and document of escalation pathway(s), research and communications
- Communicate with providers and/or members regarding their cases within required regulatory timeframes
- Make outbound calls to providers and/or members regarding their cases, to aid in your research and resolution process
- Work collaboratively and cross-functionally with other departments in internal systems and/or email
- Identify operational issues and trends observed from the management of your cases, and communicate these issues to the Complaints, Grievances, and Appeals Leadership
- Attend and actively participate in team meetings, operational meetings, trainings and coaching sessions
- Write response letters within required regulatory timeframes, to ensure mailing by regulatory due date(s)
- Assist with training material and department knowledge support
- Work assigned Special Projects as business needs require
- Uphold/overturn medical claims as appropriate
Customer Service Teammate
PayPal Credit
Chandler, Arizona
04.2017 - 10.2018
- Inbound calls to assist account holders with fraud, payments, statements, declines, troubleshooting, overflow from other departments and other miscellaneous inquiries
- Promoted to blended agent in May2017, which entailed servicing frontline phone calls and inbound email inquiries in regards to PayPal Credit and overflow
- Assist PayPal Protection Services by also working PayPal Buyer Protection claims (Disputes and Claims) and emails due to previous role experience; moved to this role due to business need and outsourcing
Disputes and Claims Teammate
PayPal
Chandler, Arizona
07.2016 - 03.2017
- Inbound calls to assist account holders with filing disputes, servicing disputes, transactions, purchases, sending/receiving money, overflow from other departments, and other miscellaneous inquiries
Customer Service Representative
UCG
Gilbert, Arizona
06.2015 - 06.2016
- Inbound calls to assist Las Vegas Review Journal newspaper account holders by taking payments, adjusting rates, resolving miscellaneous inquiries, and opening/closing accounts
Customer Service Representative
GC Services
Mesa, Arizona
10.2013 - 12.2014
- Inbound calls to assist Apple customers with disputes, pick-up orders, online orders, and other miscellaneous inquiries
Patient Assistance Counselor
Spectraforce Technologies Inc.
Education
N/A - Introduction To Microsoft Excel
Coursera
OnlineGeneral Education Diploma (GED) -
Red Mountain Community College
Mesa, ArizonaSkills
- Problem Solving
- Critical Thinking
- Adaptability
- Leadership
- Knowledge Management
- Communication
- Team Work
- Individual Work
- Time Management
- Customer Service
- Business Writing
- Attention to Detail
- Managing Ambiguity
Timeline
Patient Assistance Counselor
AbbVie via Spectraforce Technologies Inc. (Remote)
02.2025 - Current
Complaints, Grievances, and Appeals Liaison
Oscar Health Insurance
08.2021 - 10.2024
Care Guide
Oscar Health Insurance
10.2018 - 08.2021
Customer Service Teammate
PayPal Credit
04.2017 - 10.2018
Disputes and Claims Teammate
PayPal
07.2016 - 03.2017
Customer Service Representative
UCG
06.2015 - 06.2016
Customer Service Representative
GC Services
10.2013 - 12.2014
Patient Assistance Counselor
Spectraforce Technologies Inc.
N/A - Introduction To Microsoft Excel
Coursera
General Education Diploma (GED) -
Red Mountain Community College