Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
Highlights Aligned With The Role
Work Availability
Affiliations
Quote
Software
Languages
Timeline
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Goretti Tibeme

Goretti Tibeme

Fort Worth,TX

Summary

Team Leader experienced in directing activities of workgroups. Develops strategies, provides training, sets goals and obtains team feedback. Excellent interpersonal and communication skills. Big picture focus with excellence in communicating goals and vision to succeed. Problem solver, networker, and consensus builder.

Overview

9
9
years of professional experience
1
1
Certificate

Work History

Provider & Member Outreach Team Lead (Remote)

Centene
Dallas, TX
04.2024 - Current
  • Led outreach and issue resolution for Medicaid providers and members across multiple programs, improving resolution time by 30%.
  • Managed escalated provider concerns, claims, eligibility, and network navigation, resolving 95% of cases within SLA.
  • Ensured HIPAA compliance; verified member eligibility and HIPAA status using Omni and Amysis.
  • Used Power BI to monitor provider network status and ensure accurate in-network verification.
  • Coordinated and managed team meetings using Jira to track action items and project progress.
  • Monitored employee call quality and schedules with NICE/CX, improving service standards.
  • Developed training and onboarding materials; coached 20+ team members, boosting performance scores by 15%.
  • Processed bi-weekly payroll for 20 employees with 100% accuracy.
  • Enhanced customer satisfaction by resolving 50+ inquiries daily, increasing CSAT by 20%.
  • Collaborated cross-departmentally to reduce call wait times by 25% and increase first-call resolution by 18%.
  • Conducted performance reviews; managed hiring and training, reducing turnover by 10%.
  • Streamlined scheduling and office operations, improving workflow efficiency by 22%.
  • Applied project management techniques to increase team productivity by 17%.

Salesforce Business Analyst/Quality Assurance

Applications Software Technology LLC (AST)
Dallas, TX
08.2021 - 03.2024
  • Led requirements gathering and documentation during client meetings for Massachusetts Department of Telecommunications and Cable project, ensuring deliverables aligned with stakeholder needs and regulatory standards
  • Performed end-to-end QA testing of Salesforce forms, workflows, and integrations to verify accuracy, functionality, and compliance before release
  • Logged and tracked issues in Jira, collaborating with DevOps and development teams to ensure timely resolution and deployment of updates
  • Partnered cross-functionally with developers, business analysts, and project managers to maintain clear communication channels between business and technical teams
  • Supported successful go-live of Massachusetts Department of Telecommunications and Cable Salesforce Document Management solution, enabling efficient processing of online form intake and ongoing production operations
  • Achieved Customer Satisfaction Rating of 4.50/5, including perfect scores (5/5) in keeping clients informed, managing risk appropriately, applying Salesforce technology to client needs, producing valuable outcomes, and enabling clients to maintain solutions

Senior Patient Support Specialist (Hybrid)

UnitedHealth Group
Irving, TX
06.2018 - 07.2021
  • Managed 70+ inbound calls daily using Avaya phone system, scheduling physicals, sick visits, consults, follow-ups, and wellness exams in alignment with physician scheduling preferences
  • Coordinated provider–patient communication via Epic EMR and HIPAA-compliant secure messaging, achieving first-call resolution for the majority of scheduling and operational inquiries
  • Acted as primary liaison among patients, families, physicians, and healthcare staff, ensuring timely task completion and accurate information transfer
  • Resolved escalated scheduling, billing, and insurance-related concerns with professionalism, contributing to top 10% ranking in call quality and satisfaction metrics
  • Maintained 100% accuracy in patient record updates and referral processing within Epic, ensuring full HIPAA compliance across 1,500+ records
  • Improved scheduling efficiency by 15% through workflow optimization and Epic navigation best practices
  • Trained and onboarded 5+ new hires in Epic, scheduling workflows, and call-handling procedures, accelerating team productivity and reducing ramp-up time

Technical Support Specialist

Amazon
Irving, TX
06.2016 - 06.2018
  • Handled 80+ technical inquiries daily via phone, chat, and email, resolving account access, device, and digital services issues for customers
  • Troubleshot and supported internal portals for member and provider records, claims processing, and scheduling tools, maintaining high system uptime
  • Documented recurring technical patterns and escalated trends to development teams, reducing repeat issues by 12%
  • Leveraged Zendesk and Salesforce Service Cloud to log and track tickets, ensuring accurate case management and timely resolution
  • Educated users on navigation, system access, and security best practices, increasing first-contact resolution rate by 15%
  • Collaborated cross-functionally with product, engineering, and operations teams to address systemic issues and recommend improvements

Education

Certificate of Completion - Salesforce

Per Scholas
Dallas, TX
02.2023

Bachelor of Science - Business Administration

Texas Woman's University
Denton, TX
05.2016

Associate of Arts - General Studies

Panola College
Carthage, TX
05.2013

Skills

  • Salesforce Administration
  • Jira
  • Power BI
  • Epic EMR
  • Avaya
  • NICE/CX
  • Omni
  • Amysis
  • Microsoft Office Suite
  • Zendesk
  • Salesforce Service Cloud
  • HIPAA Compliance
  • Business Requirements Gathering
  • Process Improvement
  • Data Analysis & Reporting
  • Agile Project Management
  • Waterfall Project Management
  • SLA Compliance
  • Root Cause Analysis
  • Stakeholder Coordination
  • Performance Tracking
  • Claims Processing
  • Escalation Management
  • Eligibility Verification
  • High-Volume Inquiry Handling
  • CSAT Improvement
  • Training & Onboarding
  • Cross-Department Collaboration
  • Payroll Processing
  • Communication Skills
  • Problem-Solving
  • Time Management

Certification

  • Salesforce Administrator, Salesforce, 2023
  • Omnistudio Consultant, Salesforce, 2024

Accomplishments

  • Reduced provider and member issue resolution time by 30% through proactive outreach and streamlined workflows.
  • Resolved 95% of escalated provider concerns, claims, and eligibility inquiries within SLA guidelines.
  • Improved CSAT by 20% by handling 50+ high-priority inquiries daily with accuracy and professionalism.
  • Boosted team performance scores by 15% through developing onboarding materials and coaching 20+ employees.
  • Enhanced first-call resolution rates by 18% and reduced call wait times by 25% via cross-department collaboration.
  • Increased workflow efficiency by 22% by streamlining scheduling and office operations.
  • Achieved 100% accuracy in bi-weekly payroll processing for 20 employees.
  • Led performance reviews, hiring, and training efforts, reducing turnover by 10%.
  • Applied Agile and Waterfall project management methods to improve team productivity by 17%.
  • Utilized Jira to track and resolve form issues, enabling DevOps updates and stakeholder visibility.
  • Created and validated Salesforce forms, ensuring alignment with business requirements and client satisfaction.
  • Facilitated stakeholder communication during Massachusetts Department of Telecommunications and Cable Project as Salesforce Administrator, Business Analyst, and QA Specialist.

Highlights Aligned With The Role

  • Strong track record in remote outreach and case resolution for dental and healthcare members.
  • Direct experience using CRM tools and Salesforce for contact documentation and workflow management.
  • Capable of supporting hybrid schedules with flexibility for weekends and overtime.
  • Proven skills in provider education, claims assistance, and cross-functional communication.

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Affiliations

  • Salesforce Trailblazer Community
  • Health Information and Management Systems Society (HIMSS)
  • Business Analysis Community of Practice

Quote

The person who says it cannot be done should not interrupt the person who is doing it.
Chinese proverb

Software

Salesforce

Jira

Languages

English
Native or Bilingual

Timeline

Provider & Member Outreach Team Lead (Remote)

Centene
04.2024 - Current

Salesforce Business Analyst/Quality Assurance

Applications Software Technology LLC (AST)
08.2021 - 03.2024

Senior Patient Support Specialist (Hybrid)

UnitedHealth Group
06.2018 - 07.2021

Technical Support Specialist

Amazon
06.2016 - 06.2018

Certificate of Completion - Salesforce

Per Scholas

Bachelor of Science - Business Administration

Texas Woman's University

Associate of Arts - General Studies

Panola College

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