Cassandra Renee Deleon
Waxahachie ,TEXAS
Summary
Experienced Complex Customer Representative with extensive knowledge of medical, behavioral, and pharmacy claims, benefits, and medical terminology. Skilled in effective communication with providers and providing compassionate support to members. Proficient in educating patients and providers on appeals and prior authorizations. Ensures accuracy of financial accounts including HSA and FSA.
Overview
8
8
years of professional experience
Work History
Complex Care Advisor Sr- Remote
United Healthcare
10.2023 - Current
- Delivered holistic support to members and families with complex care needs, including special needs and chronic conditions, ensuring continuity and quality of care.
- Reviewed and resolved complex medical and pharmacy claims, prior authorizations, and benefit coverage issues with high attention to detail.
- Acted as a dedicated liaison between members, providers, and internal teams via phone, email, and chat, ensuring timely communication and resolution of concerns.
- Built and maintained strong, ongoing relationships with members, serving as their primary point of contact for care coordination and support services.
- Collaborated with providers through direct outreach (phone/fax) to verify clinical details, authorizations, and coordinate care plans.
- Referred members to appropriate internal programs and external community resources, enhancing support beyond medical needs.
- Maintained accurate family data in documentation platforms, ensuring up-to-date and organized records for each case.
- Prioritized and managed a dynamic caseload, meeting key performance indicators (KPIs) and post-contact satisfaction metrics.
- Fostered a collaborative team environment by mentoring new colleagues and sharing best practices for complex case handling.
- Analyzed and reviewed financial accounts, including Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA), to ensure accuracy and compliance.
- Collaborated with case managers, support specialists, and leadership teams to resolve client issues and streamline processes.
Conducted outbound calls to healthcare billing departments to clarify claims, obtain explanations of benefits (EOBs), and resolve discrepancies.
Inside Sales Healthcare Representative -Remote
Salelytics
03.2023 - 10.2023
- Handled a high volume of inbound and outbound calls for assigned clients, adhering to company policies and procedures
- Delivered exceptional customer service by resolving inquiries and issues efficiently
- Presented scripted sales offers with accuracy and professionalism to meet performance targets
- Consistently met or exceeded call-per-hour and sales conversion goals
- Maintained in-depth knowledge of client-specific products and services
- Completed accurate and timely documentation of customer interactions and transactions
- Fostered positive relationships with internal teams, external customers, and department contacts
Department Sales Manager
Dillard’s
02.2020 - 04.2023
- Developed and maintained strong customer relationships, building a comprehensive database to support sales initiatives and event promotions
- Consistently surpassed monthly sales targets through strategic planning and customer engagement
- Attended quarterly workshops to strengthen partnerships with vendors and collaborate with upper management
- Certified Specialist with in-depth product knowledge and expertise
- Oversaw inventory levels, ensuring stock accuracy and minimizing loss
- Set and monitored departmental sales quotas to drive team performance
- Provided coaching and mentorship to team members to support their growth and improve overall productivity
- Created and managed team schedules to ensure optimal coverage and operational efficiency
Processor Manager
Victoria Secret
06.2017 - 01.2020
- Replenish merchandise to maintain brand standards
- Assist with markdowns, re-ticketing, and out-of-stock processes
- Support merchandise displays and floor-set activities
- Maintain product knowledge to assist customers and team members
- Train new employees on company policies and procedures
- Process inbound shipments accurately and efficiently
- Maintain organized and clean back room and under-stock areas
Education
Alice High Scool
05.2011
Skills
- Leadership
- Marketing and Sales
- Time Management
- Professionalism
- Stress Management
- Critical Thinking
- Confidence
- Communication (Excellent)
- MS Office (Excel, Word, PowerPoint, etc)
- Genesys
- Drug Formularies via Optum Rx
- Salesforce-ISET/ACET
Professional Skills:
Technical Skills:
- Linx
- SENS
- ICUE
- Microsoft Excel (Advanced)
- Evicore
- Viewing Medical & Behavioral Claims, Prior Authorization’s, Appeals, Financial Accounts (HSA & FSA), Medical & Behavioral Health Benefits, Coordination of Benefits, Explanation of Benefits, and deductible’s and out of pocket max
- Thorough Understanding of HIPAA and Privacy Policies
- Alert and Observant
- Physical and Mental Endurance
- Detail-Oriented
- Kind and Compassionate
Industry-Specific Knowledge:
Personal Traits:
Timeline
Complex Care Advisor Sr- Remote
United Healthcare
10.2023 - Current
Inside Sales Healthcare Representative -Remote
Salelytics
03.2023 - 10.2023
Department Sales Manager
Dillard’s
02.2020 - 04.2023
Processor Manager
Victoria Secret
06.2017 - 01.2020
Alice High Scool