Erika Rubio

Lead the Customer Outreach team, delivering education, support, and outreach across Medicaid and Marketplace.

• Oversee all HHSC and Marketplace outreach campaigns, including AAPCA, CTW, recertification reminders, preventive care outreach, and interpreter services support. Manage provider/member request workflows, including appointment coordination, benefit education, and PCP change assistance. Completing between 5,000 and 12,000 calls monthly.
• Manage IVR operations, including script updates, voice recordings, and testing to ensure accurate, clear, and compliant messaging.
• Provide vendor oversight for NICE and Spectrio, ensuring timely updates, quality execution, and successful system enhancements.
• Lead cross-functional testing and quality reviews to ensure all IVR and outreach products are 100% accurate and ready before go-live.
• Collaborate with IT, Quality, Compliance, and Provider Relations to align workflows and improve the member experience.

• Developed customer engagement strategies to enhance member satisfaction and retention.
• Led cross-functional teams to implement initiatives improving communication with members.
• Analyzed customer feedback to identify trends, driving enhancements in service delivery.
• Created training programs for staff on best practices in member engagement and support.
• Manage IVR operations for the contact center.
• Conduct recordings for the IVR, coordinate updates to the main AccuCare, and clear messaging.
• Assist with vendor oversight for NICE and Spectrio, ensuring timely implementation.
• Led end-to-end testing to validate all IVR products and functionality. Ensuring readiness and accuracy prior to go live.

• Supervised and supported the inbound with questions, escalations throughout the day. Monitored and coached the team to successfully meet daily goals regarding Quality, Service Level and Average Handle Time (AHT) Prepared and analyzed internal reports for management staff review
• Completed daily duties: Daily Call Stats Report and Support Tickets, Transportation Request, Complaint resolution, Daily work distribution, Review Incoming emails with timely reply.
• Complete Monthly Scorecards, and evaluate performance with direct reports
• Reviewed timecards in accordance to Harris Health System Policy

• Supervised inbound provider services team and aided daily with questions and escalations regarding Claims, Authorization and Coordination of Benefits.
• Monitored and coached the team to successfully meet daily goals regarding Quality, Service Level and Average Handle Time (AHT) Prepared and analyzed internal reports for management staff review.
• Completed daily duties: Provider Communication Forms, after hours Voicemails, Provider Web Inquiries, Daily Call Stats Report and Support Tickets.
• Complete Monthly Scorecards and evaluate performance with direct reports.
• Reviewed time cards in accordance to Harris Health System Policy

• Obtained clarification of information provided during the complaint intake process, made concise descriptions and information based on policies for HHSC, Marketplace and ERS.
• Completed HICS Marketplace Case Escalations from CMS daily.
• Made sure complaint files are and closed in a timely manner per procedure.
• Adhered to strict timelines and meeting deadlines to assure regulatory compliance per total metrics. Maintained training records and data for all departments in the company.
• Maintained all related documents to each complaint for future reference if needed

• Supervised and assisted the inbound with questions, escalations throughout the day. Monitored and coached the team to successfully meet daily goals regarding Quality, Service Level and Average Handle Time (AHT) Prepared and analyzed internal reports for management staff review
• Completed daily duties: Daily Call Stats Report and Support Tickets, Transportation Request, Complaint resolution, Daily work distribution, Review Incoming emails with timely reply.
• Complete Monthly Scorecards, and evaluate performance with direct reports
• Reviewed timecards in accordance to Harris Health System Policy

• Contributed with 60+ Incoming calls from Members and Providers for the following: Benefits, Claims, Complaints and Eligibility and Payment and billing Inquiries. Respond to Member inquiries in a confident, timely and accurate manner
• Meets the expectations of our internal and external stakeholders in providing excellent service and one call resolution Cross-trained and provides back-up for other lines of business when needed. Assist with Lead duties (Call backs, web inquiries, and Communication Contact Forms)

• Answer and call track incoming calls related to eligibility and provide information regarding all CHC benefit plans.
• Document calls with regards to Marketplace, STAR, CHIP, CHIP Perinatal and Tex Health. Other duties include answering pharmacy calls, CHC Service Delivery Areas, CHC special programs, THSTEPS & Well Child Check – ups, COB
• Member complaint process, Assistance with finding or changing primary providers or specialist.
• Conducting training for new Marketplace representatives. Work from home doing web emails for STAR/CHIP and Marketplace.
• Work from home doing web emails for STAR/CHIP and Marketplace.

• Assist patients with Inbound 70+ calls daily appointment setting and obtain messages for our Medical Group of 30 Providers
• Maintained a professional, friendly demeanor with patients always while de-escalating issues to other departments in the organization.
• Established knowledge of Clinic protocols for our members answering patient inquiries with accuracy Work with E-Clinical system