Blanca Agabo
Rialto
Summary
Results-driven Healthcare Operations Manager and California Licensed Life, Accident & Health Insurance Producer with more than 15 years of progressive leadership experience across health plan operations, member services, care coordination, quality assurance, workforce development, and healthcare insurance programs. Demonstrated success leading high-performing teams, improving operational efficiency, enhancing member experiences, and driving compliance with regulatory and organizational standards. Known for transforming complex challenges into effective solutions through strategic leadership, employee development, process improvement, and cross-functional collaboration. Combines deep expertise in Medicare, member advocacy, quality management, and healthcare operations with a strong commitment to delivering exceptional service and measurable outcomes. Bilingual in English and Spanish.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Care Navigator 4 You Manager
Homebase Medical
02.2024 - Current
- Lead daily operations for the CN4U team, ensuring timely case management, member advocacy, and resolution of complex access-to-care challenges.
- Strengthened quality performance through routine case audits, coaching initiatives, and service reviews.
- Improved operational effectiveness through workflow management, documentation standards, and productivity initiatives.
- Conduct team capacity planning and performance reviews aligned with organizational priorities.
- Conduct Health Risk Assessments and support care gap closure initiatives.
- Mentor and develop team members through coaching, training, and performance management.
MS Quality Assurance Specialist
SCAN Health Plan
10.2021 - 02.2024
- Conducted quality audits and call monitoring reviews to ensure compliance.
- Partnered with leadership to implement coaching strategies and improve performance.
- Facilitated training programs, calibration sessions, and quality initiatives.
- Delivered detailed audit analyses and reporting supporting continuous improvement.
HR Trainer
SCAN Health Plan
06.2020 - 10.2021
- Led onboarding programs for Member Services employees.
- Developed a seven-week training curriculum covering systems, pharmacy benefits, and compliance.
- Supported transition to the SHELF knowledge management platform.
- Provided coaching and performance assessment support.
Concierge
SCAN Health Plan
12.2018 - 06.2020
- Directed daily floor support activities for customer service teams.
- Resolved complex member escalations and improved satisfaction.
- Conducted quality reviews and identified coaching opportunities.
- Generated operational reports supporting leadership decisions.
MS Pharmacy Specialist
SCAN Health Plan
01.2015 - 12.2018
- Managed complex pharmacy benefit, authorization, and coverage issues.
- Collaborated with providers, pharmacies, and internal departments.
- Handled high-volume inquiries with accuracy and compliance.
- Advocated for members through proactive problem resolution.
Member Services Advocate Senior Representative
SCAN Health Plan
12.2014 - 01.2015
- Managed escalated member issues requiring advanced problem-solving.
- Supported organizational 5-Star quality initiatives.
- Served as a resource for peers and team members.
Correspondence Representative
American Medical Response
01.2011 - 12.2014
- Managed insurance verification and patient account investigations.
- Collaborated with collection agencies and insurance carriers.
- Improved account resolution outcomes through detailed follow-up.
Collections Specialist / Medical Biller
DRSL
01.2007 - 12.2011
- Managed medical billing and collections for personal injury and workers' compensation claims.
- Increased claim resolution rates through effective payer follow-up.
- Maintained compliance with HIPAA and FDCPA regulations.
Education
High School Diploma -
John Glenn High School
Rio Hondo Community College
Skills
- Healthcare Operations Leadership
- Team Management & Staff Development
- Care Coordination & Member Advocacy
- Quality Assurance & Regulatory Compliance
- Medicare Advantage & Health Plan Operations
- Healthcare Insurance Sales
- Licensed Health Insurance Producer
- Performance Improvement Initiatives
- Training & Workforce Development
- Call Center Operations
- Escalation Management
- Data Analysis & Performance Reporting
- Process Optimization
- Cross-Functional Collaboration
- Strategic Problem Solving
- Conflict Resolution
- Relationship Building
- Bilingual Communication
Certification
- California Licensed Life, Accident & Health Insurance Producer
- Medicare Advantage and Health Plan Benefits Knowledge
- Healthcare Insurance Sales and Member Education
- Regulatory Compliance and Member Advocacy
LANGUAGES
Spanish – Advanced
Timeline
Care Navigator 4 You Manager
Homebase Medical
02.2024 - Current
MS Quality Assurance Specialist
SCAN Health Plan
10.2021 - 02.2024
HR Trainer
SCAN Health Plan
06.2020 - 10.2021
Concierge
SCAN Health Plan
12.2018 - 06.2020
MS Pharmacy Specialist
SCAN Health Plan
01.2015 - 12.2018
Member Services Advocate Senior Representative
SCAN Health Plan
12.2014 - 01.2015
Correspondence Representative
American Medical Response
01.2011 - 12.2014
Collections Specialist / Medical Biller
DRSL
01.2007 - 12.2011
High School Diploma -
John Glenn High School
Rio Hondo Community College