DEBORAH SANTOS ALMESTICA
Pflugerville,USA
Summary
Highly organized and dependable candidate with experience in effectively managing multiple priorities while maintaining a positive attitude. Demonstrates a strong willingness to take on additional responsibilities to meet team goals. Proven track record of successfully navigating complex tasks and delivering results. Dedicated professional committed to contributing to the overall success of the organization.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Program Specialist II
Texas Department of Health
05.2024 - 08.2024
- Worked as a contractor through GSG Talent Solutions for DSHS HIV/STD/HCV Epidemiology and Surveillance unit in the Data Management & Analytics group, job duties involved:
- Performed quality assurance on data within the HIV and STD surveillance system (THISIS)
- Deduplicate patient data
- Maintained data, reporting and quality assurance standards throughout investigations.
- Managed quality assurance spreadsheets in Excel on secure network drive
- Interpret laboratory report data and correct final test result mapping
- Collected and organized data for weekly case summaries.
- Ensured compliance with relevant regulations governing patient privacy and security within systems.
- Worked on other projects or assignments as needed.
Program Specialist
Texas Department of Health Services
08.2023 - 05.2024
- Worked as a contractor through Peak Performers Agency for the ADAP program.
- Determined the eligibility of applicants.
- Documented all client interactions and relevant information in writing and electronically.
- Prepared written correspondence (via Microsoft Word) for applicants, requesting missing information or additional documentation.
- Ensured that recertification timelines, as outlined in the procedure manual, were met.
- Assisted clients coordinating and mailing of new and recertification packets, and documents.
- Researched, compile, and evaluated data.
- Consulted with Program Specialist V on rejected applications, special exceptions, and appeals.
- Received and extracted data from Excel spreadsheets, downloaded applications, and supporting documents to create clients' folders, and moved applications to folders for processing
- Additionally, answered phone calls from clients who wanted to learn about the program and provided updates on their application status
- Worked on other projects as needed
Pharmacy Customer Service Representative
US Department of Veterans Affairs
02.2022 - 12.2023
- Helped resolve issues and concerns of veterans, veteran family members and/or legal representatives, the public, and VA employees concerning pharmacy support activities
- Demonstrated adaptability through cross-training in various roles within the pharmacy setting to better serve customers as needed.
- Administrated processes related to pharmacy services provided to our nation's veterans
- Ensured regulatory compliance by diligently adhering to pharmacy policies, procedures, and applicable laws during daily operations.
- Supported team members in achieving company goals by consistently meeting individual performance targets.
- Managed confidential patient records with meticulous attention to detail while upholding privacy standards.
- Expedited prescription refills with timely coordination between patients, prescribers, and insurance companies.
- Delivered exceptional service during high-volume periods, maintaining composure under pressure while managing multiple tasks simultaneously.
- Reduced wait times with accurate and efficient prescription processing, ensuring a seamless customer experience.
- Answered customer questions regarding prescribed medications, over-the-counter products, and insurance coverage.
- Processed payments, returns and exchanges using pharmacy POS system to accurately manage transactions.
Healthcare Navigator
Karis Group LLC
01.2023 - 07.2023
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
- Maintained accurate records of customer interactions, ensuring proper documentation within the company''s database.
- Developed strong relationships with clients by providing empathetic support and understanding during challenging health situations.
- Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
- Facilitated smooth communication between patients, insurance companies, and medical staff for seamless coordination of care.
- Streamlined appointment scheduling process by utilizing advanced software tools, optimizing time management for both patients and medical professionals.
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Educated customers about billing, payment processing and support policies and procedures.
Consumer Experience Specialist
AdventHealth
09.2021 - 12.2021
- Articulated the mission of AdventHealth and the CxC
- Developed strong relationships with clients, leading to increased trust and repeat business.
- Aligned team objectives with organizational goals, resulting in an increased level of overall success and employee engagement.
- Streamlined department processes for improved efficiency and productivity.
- Researched and resolved complex issues to facilitate prompt resolution.
- Collaborated with cross-functional teams to achieve project goals on time
- Ensured patients were appropriately registered for all service lines.
- Performed eligibility verification, obtained pre-cert and/or authorizations.
- Made financial arrangements, requests and receives payments for services.
- Cleared registration errors and edited pre-bill.
- Maintained close working relationship with clinical partners to ensure continual open communication between clinical, ancillary and patient access departments.
- Actively participated in extending exemplary service to both internal and external customers and accepted responsibility in maintaining relationships and equally respectful to all.
- Provided PBX (switchboard) coverage and support as needed.
- Other duties as required
Customer Service Representative II
Centene Corporation
01.2019 - 05.2021
- Transitioned from contract employee to permanent.
- Worked as a Bilingual Member Service Representative and Behavioral Health Services.
- Responded to telephone or written correspondence inquiries from members and/or providers within established time-frames utilizing reference materials and available resources.
- Recognized as a top performer consistently meeting or exceeding key performance indicators related to call handling time, first-call resolution rates, and customer satisfaction scores.
- Championed initiatives aimed at improving employee morale and engagement, ultimately reducing turnover rates within the department.
- Assisted in new staff training on operating procedures and company services.
- Educated customers about billing, payment processing and support policies and procedures.
- Provided assistance to members and/or providers regarding website registration and navigation.
- Documented all activities for quality and metrics reporting through the Customer Relationship Management applications.
- Processed written customer correspondence and provided the appropriate level of timely follow up and made referrals to other departments as appropriate
- Maintained performance and quality standards based on established call center metrics including turnaround times
- Worked on other projects or assignments as needed
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
- Collaborated with team members to develop best practices for consistent customer service delivery.
Customer Service Representative
Kforce
06.2018 - 01.2019
- Worked as a Bilingual Member Service Representative and Behavioral Health Services for Centene Corpotation through temporary agency.
- Developed strong rapport with customers through active listening skills, empathy, and patience in handling their concerns.
- Improved team performance by providing constructive feedback, guidance, and encouragement to fellow Customer Service Representatives.
- Served as a trusted resource for colleagues seeking guidance on challenging situations or complex issues faced during daily interactions with customers.
- Handled escalated calls professionally while working towards amicable resolutions that satisfied both parties involved.
- Streamlined processes for efficient communication between customers and various departments within the company.
- Implemented innovative strategies aimed at reducing wait times for callers without compromising on quality of support provided.
- Maintained up-to-date knowledge of industry trends, product offerings, and competitor strategies to provide superior support to clients.
- Assisted supervisor monitor customer service calls to verify representatives' adherence to service standards and best practices.
- Worked on other projects or assignments as needed.
Premier Support Specialist
Asurion Insurance Services
12.2016 - 06.2018
- Served as a trusted advisor for clients seeking guidance on product usage or configuration best practices, promoting continued business growth.
- Technical background encompassing both software and hardware knowledge, troubleshooting, problem solving, team collaboration, and customer service expertise
- Streamlined support processes for improved issue resolution and increased client retention.
- Train in a variety of computer applications, databases, remote access applications, software and network configurations
- Utilized strong interpersonal skills during phone calls with customers who were experiencing frustrations due to technical difficulties; maintained professionalism under pressure while successfully resolving issues.
- Enthusiasm for investigating and resolving challenging issues, building a structured plan of action to resolve while keeping our customers informed on progress and delivering a positive outcome
- Participated in ongoing product testing to identify potential bugs and provide valuable feedback for developers, ensuring a high-quality user experience for clients.
- Maintained comprehensive documentation of all support interactions, enabling seamless handover of cases when necessary.
- Collaborated with cross-functional teams to address complex technical issues, ensuring optimal solutions for clients.
- Managed multiple high-priority tasks simultaneously without compromising quality or responsiveness to clients'' needs.
- Delivered exceptional customer service through active listening, empathetic understanding, and prompt problemsolving.
- Escalated critical issues promptly to appropriate departments while maintaining clear communication with clients throughout the process.
- Participated in ongoing training programs to stay current with industry developments and enhance technical expertise.
- Provided remote troubleshooting assistance for various operating systems, software applications, and hardware devices, resolving issues efficiently and effectively.
- Implemented new knowledge base articles within the company''s internal resources database to aid in quicker case resolutions for future inquiries from colleagues or customers alike.
- Mentored junior team members in customer service best practices, contributing to overall team performance improvement.
- Worked on other special projects as need it.
Pharmacy Help Desk Representative
Aerotek
02.2016 - 12.2016
- Stayed current with industry trends by attending relevant training sessions and conferences.
- Responded to incoming calls from customers on issues related to benefit eligibility and prescription status inquiries
- Maintained exceptional first-call resolution rates through diligent troubleshooting and problem-solving skills.
- Assisted, guided and educated customers on their prescription benefits, use of their insurance plan, formulary, premiums and status of orders, and claims or inquiries
- Prompted appropriate questions and listened actively to identify any questions or issues while documenting required information in computer systems
- Identified issues and communicate solutions and steps to customers, pharmacies, and physicians with prescription orders
- Consulted or escalated drug related calls as appropriate to the Prior Authorization department for resolution
- Coordinated internal resolution of claims exceptions and other issues to include determining appropriateness of overriding pharmacy claims edits and error messages
- Made outbound calls to customers on prescriptions rejections claims
- Met monthly performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, and attendance
- Achieved high levels of user satisfaction through consistent follow-up on outstanding tickets until resolution.
- Supported users during system migrations, minimizing downtime and disruptions to daily operations.
Customer Service Representative
Avery Partners
11.2014 - 12.2015
- Bilingual Call Center Representative provided prompt professional customer service for the Department of Labor Workers Compensation Programs (FECA, Black Lung and Energy).
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Assisted with questions concerning program enrollments, prior authorizations for medical services
- Ensured that all problems were promptly addressed, documented and rectified accurately and on time with proper follow-up and professional customer service
- Worked on special projects for the re-enrollment program, verifying provider's enrollment data and making necessary updates and changes on the system as necessary
- Expanded knowledge on medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
- Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
- Worked on other duties as assigned
Regulatory Specialist II
DBPR- DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATIONS
10.2008 - 08.2013
- Answered incoming calls for Customer Contact Center (Spanish and English) in a courteous and professional manner, assist callers with inquiries and provides accurate information in accordance with Department policy and procedures as well as Florida statute and rules
- Enhanced regulatory compliance by developing and implementing robust policies and procedures.
- Provided expert guidance on regulatory requirements, supporting the development of compliant products and services.
- Processed requests for public records
- Ensured timely renewal of licenses and registrations through meticulous tracking systems, preventing lapses that could impact business operations.
- Monitored changes in legislation, adjusting company policies accordingly to maintain compliance standards.
- Reviewed customer's applications and documents in the OnBase system to determine the correct index type and correct transaction
- I was promoted twice within my first two years and receive awards and recognitions
- Worked on other duties as assigned
Florida Choice Counselor
Affiliated Computer Services/Xerox
09.2007 - 10.2008
- Worked as a bilingual (Spanish and English) Choice Counselor in a high volume inbound call center for Florida Medicaid Reform
- Coordinated outreach events within the community, raising awareness about available choice counseling resources and attracting new clientele through proactive engagement efforts.
- Maintained up-to-date knowledge of state regulations and policies related to healthcare options, ensuring accurate information dissemination to clients.
- Assisted clients with navigating complex healthcare options for optimal decision-making and enrollment success.
- Assisted department with application processing
- Responded to questions about the program and provided applications status, renewals, and enrollments into health insurance plans.
- Trained new choice counselors on company policies and procedures, equipping them with the necessary knowledge and skills to provide exceptional client support.
- Provided ongoing support to clients during the enrollment process, ensuring a smooth transition into their chosen healthcare plan.
- Ensured timely follow-up with clients after initial consultations, addressing any questions or concerns promptly while solidifying trust in our services.
- Conducted comprehensive assessments of client needs, effectively matching them with appropriate healthcare services.
- Managed confidential client records meticulously, safeguarding sensitive personal information in compliance with privacy regulations.
- Displayed sensitivity to cultural and linguistic needs of clients and families served.
- Provided comprehensive case management services, and connected clients and families to appropriate resources.
- Worked on other duties as assign
Customer Service Representative II
Total Systems (TSYS)
09.2006 - 08.2007
- Worked as a bilingual (Spanish and English) customer service in a high volume inbound call center
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Assisted with phone inquiries, and provided daily support resolving and researching any problems that the customers may have on their credit cards accounts
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
- Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
- Worked on other task as assigned
Education
Master of Arts - Healthcare Administration-Informatics
University of Phoenix
06-2025
Bachelor of Arts - Healthcare Administration
Strayer University
06.2021
Skills
- HIPAA Compliance
- Healthcare Policy
- Microsoft Office
- Office Administration
- Insurance Verification
- Budgeting and finance
- Attention to Detail
- Time Management
- Multitasking
- Active Listening
- Effective Communication
- Team Collaboration
- Adaptability and Flexibility
- Decision-Making
- Training and mentoring
- Medical Terminology
- Problem-solving abilities
- Health information management
- Patient Care Coordination
- Healthcare management
- Quality Improvement
- Healthcare compliance
- Health Information Systems
Certification
Driver's License, 08/01/17, 08/01/25
Personal Information
- Willing To Relocate: Anywhere
- Authorized To Work: US for any employer
Affiliations
- The National Society of Leadership and Success Memer Since 2024
- The American College of Healthcare Executives Member Since 2024
Languages
Spanish
Native or Bilingual
English
Full Professional
Timeline
Program Specialist II
Texas Department of Health
05.2024 - 08.2024
Program Specialist
Texas Department of Health Services
08.2023 - 05.2024
Healthcare Navigator
Karis Group LLC
01.2023 - 07.2023
Pharmacy Customer Service Representative
US Department of Veterans Affairs
02.2022 - 12.2023
Consumer Experience Specialist
AdventHealth
09.2021 - 12.2021
Customer Service Representative II
Centene Corporation
01.2019 - 05.2021
Customer Service Representative
Kforce
06.2018 - 01.2019
Premier Support Specialist
Asurion Insurance Services
12.2016 - 06.2018
Pharmacy Help Desk Representative
Aerotek
02.2016 - 12.2016
Customer Service Representative
Avery Partners
11.2014 - 12.2015
Regulatory Specialist II
DBPR- DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATIONS
10.2008 - 08.2013
Florida Choice Counselor
Affiliated Computer Services/Xerox
09.2007 - 10.2008
Customer Service Representative II
Total Systems (TSYS)
09.2006 - 08.2007
Master of Arts - Healthcare Administration-Informatics
University of Phoenix
Bachelor of Arts - Healthcare Administration
Strayer University
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