Evelin Mendez
Pembroke Pines
Summary
Results-driven Operations Manager with a proven track record in optimizing operational efficiency and streamlining processes. Skilled in leading cross-functional teams to achieve organizational goals and enhance productivity. With over 11 years of Customer Service Experience, I bring strong leadership and strategic planning skills in dynamic environments. A versatile professional with managerial experience, consistently demonstrating a high level of ownership and initiative. Exceptional work ethic and a desire to exceed company expectations, with a knack for building productive working relationships. Thrives in fast-paced, deadline-driven environments, successfully managing goals and team development. History of overseeing and managing individuals while ensuring timely completion of project deadlines.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Manager of Operations
Infinity Trucking Logistics LLC
01.2024 - 02.2025
- Established positive and effective communication among unit staff and organization leadership, reducing miscommunications, and missed deadlines.
- Identified and resolved unauthorized, unsafe, or ineffective practices.
- Successfully managed budgets, consistently meeting financial targets while maintaining high-quality standards.
- Streamlined dispatch operations by implementing efficient scheduling and routing strategies.
- Assisted in resolving conflicts between drivers or customers when necessary, employing diplomacy skills and ensuring the best possible outcomes for all parties involved.
- Directed dispatching, routing, and tracking of 3 fleet vehicles.
Manager, Referral Services
Centene Corporation
03.2022 - 12.2023
- Conduct and manage the day to day operations of the referral specialist department
- Communicate with staff to facilitate daily department functions
- Create a vision for the department and determine future needs
- Develop, implement, and maintain utilization management programs to facilitate the use of appropriate medical resources and decrease financial exposure
- Ensure that standards as defined by accrediting agencies and State contract are maintained
- Ensure compliance with federal and state regulations and contractual agreements
- Develop, implement, and maintain compliance, policies, and procedures regarding medical utilization management functions
- Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives
- Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management
- Facilitate on going communication between utilization management staff and contracted providers.
- Created monthly reports for senior management summarizing operational performance metrics.
- Developed and implemented strategies to increase customer satisfaction and loyalty.
- Coached, mentored and trained team members in order to improve their job performance.
- Conducted regular meetings with staff to discuss progress and identify areas of improvement.
- Established processes to ensure efficient workflow throughout the organization.
- Resolved conflicts between employees by providing guidance on company policies and procedures.
- Initiated new projects that resulted in increased productivity across all departments.
- Maintained up-to-date records of employee attendance, payroll information, vacation requests.
- Provided leadership during times of organizational change or crisis situations.
Supervisor, Member Complaints, Grievances and Appeals
Centene Corporation
04.2020 - 03.2022
- Supervise the Complaints function and staff
- Plan, coordinate, and monitor complaints activities
- Supervise the daily, tactical and personnel responsibilities of Complaint Coordinators
- Monitor Complaints processes and workflows and implement suggestions and improvements as needed
- Review data and prepare reports of Complaints activities to assess compliance with departmental, contractual, and regulatory performance standards
- Maintain Complaints policies and procedures Analyze, develop, implement, and monitor department related initiatives to achieve successful outcomes for assigned projects
- Act as primary liaison with State and Federal regulators related to Complaint issues and questions Prepare and present complaint data and trending to Company interdisciplinary team
- Act as lead in any internal or external complaint audits
- Prepare and present complaint performance results to Compliance Director on an ongoing basis
- Manage Complaint appeal meetings Act as primary liaison with internal managers for any issues related to Member, Provider, State and Exchange complaints.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
Supervisor, Member Advocacy, Grievances and Appeals
Centene Corporation
06.2017 - 04.2020
- Oversees and ensure that the Member Advocate team meets their goals and objectives through effective hiring, performance management, coaching and career development
- Develop, implement, and maintain materials and programs ensuring production and quality standards are met within a timely manner
- Evaluate and audit performance and identify and implement improvement opportunities to increase overall productivity and effectiveness
- Ensure processes are compliant with contractual agreements and State and Federal regulations
- Analyze and advise management of personnel, work-flow issues and trends and recommend resolutions.
Customer Service Supervisor (Member & Provider)
Centene Corporation
01.2014 - 06.2017
- Promoted a positive work environment through open communication channels, fostering team collaboration and high morale.
- Collaborated with other departments to address recurring customer concerns, improving overall service quality.
- Coached employees through day-to-day work and complex problems.
- Enhanced team productivity through regular coaching, feedback, and performance evaluations.
- Maintained up-to-date knowledge of company products and services, effectively communicating changes to the team for seamless customer support.
- Demonstrated exceptional problem-solving abilities in navigating challenging customer scenarios and finding solutions that met their needs as well as aligned with company policies.
- Managed escalated calls with diplomacy, successfully deescalating situations while ensuring satisfactory resolutions for both parties involved.
- Streamlined workflow processes for increased efficiency in handling customer inquiries and complaints.
- Responded to customer inquiries and resolved complaints to establish trust and increase satisfaction.
- Evaluated individual performance metrics to identify areas of improvement, providing targeted coaching to boost results.
- Conducted training and mentored team members to promote productivity and commitment to friendly service.
- Monitored call center data to assess trends, proactively implementing solutions for identified issues.
Team Lead (Long Term Care and Member Services)
Centene Corporation
03.2013
- Coordinate and manage workflow processes during assigned call center shifts and escalate issues requiring real-time actions to designated supervisor
- Analyze and advise supervisor of personnel and workflow issues and recommend suggestions or solutions
- Develop and implement standardized processes in collaboration with supervisors that address callers’ needs and enhance positive outcomes in the areas of customer service, quality standards, and contractual requirements
- Assist in post training activities, act as a resource for staff questions and provide assessments of staff progress and competence to trainers
- Perform concurrent quality audits and provide feedback and coaching on strategies to achieve improved performance.
Customer Service Rep (Member Services)
Centene Corporation
03.2012
- Receive and respond to all telephone or written correspondence inquiries from members within established timeframes and policies
- Assist members with plan benefits via telephone, in writing, in person or make referral to outreach representative as appropriate
- Document in the computer system all members’ issues and resolution
- Utilize current reference materials to assist and resolve any member inquiries
- May coordinate member transportation.
Contract Employee for ADP Total Source - Customer Service
KeyStaff
12.2010
- Assist callers with payroll, benefits, and HR questions; manage customer accounts.
Customer Service Advocate
Everbank
01.2010
- Multi-tasked by answering calls which consisted of assisting mortgagers with their monthly payments, homeowner’s insurance, and tax bills; responsible for providing mortgagers with accurate information as outlined in our guidelines.
Education
Associates Degree in Healthcare Administration - Health Administration
Everest University
Orange Park, FL10.2010
Skills
- Bilingual
- Excellent multi-tasking skills
- Self-motivated
- Purpose driven
- Customer Relationship Management (CRM)
- Project Management
- Innovation Management
- Lead Generation
- Staff Management
- Active listener
- Knowledge of procedural terminology and ICD-9 coding
- Knowledge of CMS Guidelines
- An experienced team leader
- Influencing, leading, and delegating abilities
- Critical thinking, decision making and problem-solving skills
- Organizational abilities
- Result oriented
- Excellent Communication skills
- Conflict resolution
- Adaptability – Efficient under pressure, always meet deadlines
- Staff Development
- Operations Management
- Strategic Planning
- Performance Management
- Workforce Management
- Policy Implementation
- Team Leadership
- Training and mentoring
- Goal oriented
- Staff management
- Customer service
- Staff development
- Operations management
Certification
- Certified in HIPPA
- OSHA and CPR
- Certified Medical Assistant
Current Education
Currently attending Grand Canyon University for BS in Health Care Administration
Personal Information
Title: Manager, Referral Services
Languages
Spanish
Native or Bilingual
English
Full Professional
Timeline
Manager of Operations
Infinity Trucking Logistics LLC
01.2024 - 02.2025
Manager, Referral Services
Centene Corporation
03.2022 - 12.2023
Supervisor, Member Complaints, Grievances and Appeals
Centene Corporation
04.2020 - 03.2022
Supervisor, Member Advocacy, Grievances and Appeals
Centene Corporation
06.2017 - 04.2020
Customer Service Supervisor (Member & Provider)
Centene Corporation
01.2014 - 06.2017
Team Lead (Long Term Care and Member Services)
Centene Corporation
03.2013
Customer Service Rep (Member Services)
Centene Corporation
03.2012
Contract Employee for ADP Total Source - Customer Service
KeyStaff
12.2010
Customer Service Advocate
Everbank
01.2010
Associates Degree in Healthcare Administration - Health Administration
Everest University
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