Catherina Gallegos
Carrollton,TX
Summary
Experienced healthcare professional with 5 years of experience in customer care and home health services. Proven expertise in care coordination, member advocacy, and resolving complex healthcare issues with empathy. Skilled in Medicare policy, benefit explanations, and cross-functional collaboration to enhance member satisfaction and streamline healthcare processes.
Overview
6
6
years of professional experience
Work History
Customer Service Advocate II - Outbound
Centene Management Company LLC
Remote, TX
06.2025 - Current
- Initiate outbound calls to Medicare members to address care gaps and schedule preventive health screenings.
- Educate members on policy updates through outbound calls, increasing member understanding and compliance.
- Verify insurance benefits with accuracy, determine coverage/benefit limits
- Maintain detailed documentation of call summaries and communications in Salesforce for quality and performance tracking.
- Support training of new team members
Customer Care Coordinator
United Health Group
Remote, TX
05.2022 - 09.2024
- Assisted members via inbound calls by locating providers, scheduling medical appointments, and arranging non-emergency medical transportation.
- Acted as a liaison and member advocate between the member/family, physician and facilities/agencies.
- Conducted outbound calls to inform Medicaid and Medicare members about available services and benefit options, enhancing healthcare access through advocacy and care coordination.
- Completed telephonic outreach to complete Health Risk Assessment to identify needs and close gaps in treatment.
- Researched medical claims and collaborated with healthcare providers to expedite claim processing.
- Documented and submitted detailed appeals to facilitate timely decision-making to ensure seamless care.
Home Health Aide
Home Watch Caregivers
Grapevine, TX
08.2020 - 05.2022
- Provided personalized care services to improve physical and emotional health of clients.
- Responded to emergencies with efficiency and composure, ensuring client safety and comfort at all times.
- Coordinated client schedules to ensure timely appointments, fostering trust with clients and families.
Education
Associate in Arts -
Tarrant County College
Hurst, TXSkills
- Medicare policy knowledge
- Healthcare advocacy
- Claim resolution
- HIPAA compliance
- CRM software expertise
- Data entry
- Microsoft Office Suite proficiency
- Organizational skills
- Multitasking
- Verbal and written communication
Timeline
Customer Service Advocate II - Outbound
Centene Management Company LLC
06.2025 - Current
Customer Care Coordinator
United Health Group
05.2022 - 09.2024
Home Health Aide
Home Watch Caregivers
08.2020 - 05.2022
Associate in Arts -
Tarrant County College