Charmaine Aquino

• Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
• Improved client satisfaction by efficiently addressing concerns or grievances in a timely manner.
• Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
• Enhanced communication between clients and providers through consistent follow-ups and progress updates.
• Research, resolve and communicate complaints and grievances filed by members and communicate Health Plan's decisions appropriately back to member or their authorized representatives
• Communicate with a diverse set of internal and external clientele to achieve excellent results in the areas of complaint and grievance handling, compliance, documentation and enhancement of the member experience.
• Meet timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues.

• Managing incoming and outgoing communications from both contracted and non-contracted providers.

• Effectively resolved provider calls, emails with basic/complex inquiries on, Claims, Authorizations, Finance, Grievance & Appeals.

• Successfully collaborated and escalated complex and urgent issues. Identified and disseminate vital information effectively.

• Developed departmental process's and guidelines for a more systematic process.

• Trained new hires successfully.

• Provide excellent service to internal and external customers. Received kudos from providers for stellar service.

• Thrive in a highly fast-paced and quality-driven environment.

• Received Performance Excellence Awards from Supervisor and Kudos from providers for exemplary service.

• Effectively resolved incoming provider calls, emails with basic/complex inquiries on Contract/Credentialing, Claims, Authorizations, Grievance & Appeals, Eligibility, PCP Changes, Provider Portal, etc.

• Successfully escalated complex and urgent issues. Identified and disseminate vital information for accuracy & efficiency.

• Recommended improvements and effectiveness through the development, evaluation, and refinement of policies and procedures.