Hazel Salcedo
West Sacramento,CA
Summary
I am actively seeking a role where I can leverage my excellent customer service, strong communication and analytical skills along with experience in benefits eligibility, authorizations, medical claims, appeals, scheduling to contribute to a high-quality customer service experience with integrity in a strong career and growth possibilities.
Overview
35
35
years of professional experience
1
1
Certification
Work History
Customer Experience Associate II
Magellan Health
06.2023 - 12.2025
- Customer advocate advanced role dealing with Mental Health Benefits supporting members and providers, facilitating care and service.
- Assisting Magellan's members, providers, and clients regarding various aspects of provider lists, benefits, claims, appeals, and authorizations, programs, policies, and procedures.
- Handling incoming/outgoing calls related to Mental Healthcare related benefits.
- The administration of intake documentation into the appropriate systems for tracking.
- Providing outstanding service to internal and external customers and striving to resolve callers’ needs on the first call.
- Meet and exceed customers’ expectations and our quality standards with eligibility, benefits, claim status, authorizations, EAP services, crisis call, and other call types.
- Supporting team members, processes and/or projects.
- Mentoring new hires as SME for phone lab to prepare them to join the team.
- Claims Resolution Specialist cross training reviewing and reprocessing claims as necessary. Hands-on experience in encounter data submissions
- Processing Follow-up Form complaints cross training to load to software tracking system.
- Supporting in Lead Chat with excellent customer service and resolutions for Customer Experience Associates acting as SME.
Caregiver
In-Home Supportive Services (IHSS)
05.2021 - 08.2023
- Providing excellent customer service and care, administering medication and meal preparation.
- Performing transfers to and from wheelchair. Bathing, dressing and toiletry services.
- Provided a safe environment for exercising and walking.
- Cleaning the room and making bedding.
- Handling finances, paying bills and maintaining a balanced checkbook.
- Providing transportation and accompaniment to doctors’ visits.
- Providing wound care and administered IV home infusion.
Life Insurance Agent
American Income Life
02.2022 - 01.2023
- Conducting quality calls to secure appointments for Insurance Presentations and Sales
- Utilizing resources to manage quality confidential insurance records, database in a timely manner
- Working with management to identify and address quality and service improvements
- Facilitating Insurance Presentations via Zoom Meetings educating clients on insurance coverage needed
- Ensuring accuracy and relevancy of Insurance processes and procedures
- Attending ongoing training weekly to increase knowledge and stay informed on the latest trends
Quality Assurance Analyst
TriWest Healthcare Alliance
04.2016 - 11.2020
- Conducting quality call monitoring, facilitating training, and feedback to Contact Center Operations staff for authorizations, scheduling, claims and appeals.
- Performing member scheduling with specialists, primary care providers and creating authorizations for the Veterans program.
- Utilizing resources to manage quality audit reviews of staff in a timely manner
- Working with management to identify and address quality and service improvements
- Analyzing identified training needs and developing training based on quality reviews, coordinating with Human Capital (HC) for curriculum updates and facilitating additional training opportunities as necessary
- Ensuring accuracy and relevancy of training for Contact Center Operations processes and procedures
- Mentoring new hires for quality assurance program to join the team
- Performing research, analyzing data, and reported findings on special projects for management
Patient Service Representative
TriWest Healthcare Alliance
03.2016 - 04.2016
- Managing a high-volume workload within a deadline-driven environment maintaining metrics goals; ATT, NI, and AHT for a scheduling service
- Consistently meeting or exceeding call center requirements while utilizing resources to manage quality calls in a timely manner
- Mentoring new hires for Patient Service Representatives to join the team
Patient Service Representative
Aerotek
10.2015 - 03.2016
- Managing a high-volume workload within a deadline-driven environment maintaining metrics goals; ATT, NI, and AHT for a scheduling service
- Consistently meeting or exceeding call center requirements while Utilizing resources to manage quality calls in a timely manner
Supervisor
Centene
06.2014 - 05.2015
- Supervising, training, mentoring, and developing the team overseeing call center daily operations for twenty representatives
- Analyzing and monitoring calls collecting/synthesizing quantifiable data to measure performance
- Mentoring staff to achieve call center standards with 35,000 call volume monthly for a Managed Care Plan
- Working in a fast-paced production environment for a scheduling service
- Monitoring Contact Center performance levels, identifying trends and training needs, and develops action plans for staff development
Business Analyst
HP Enterprise Services
01.2012 - 04.2014
- Supervising, training, mentoring, and developing the team overseeing call center daily operations for twenty representatives with the In-Home Supportive Services (IHSS) processing payroll information for members.
- Developing and executing training plans for call center agents
- Analyzing and monitoring calls collecting/synthesizing quantifiable data to measure performance
- Mentoring staff to achieve call center standards with 40,000 call volume monthly for IHSS payroll account
- Monitoring Contact Center performance levels, identifies training needs, and develops action plans for staff development
Trainer & Quality Assurance Analyst
HP Enterprise Services
08.2006 - 11.2011
- Developing and executing training plans for call center agents for Medi-Cal account for five to thirty agents
- Background in Medicaid product management or support
- Analyzing and monitoring calls collecting/synthesizing quantifiable data to measure performance
- Mentoring staff to achieve call center standards
- Working with agents to provide knowledge development
- Conducting trend analysis to quantify recommendations
- Serving as Subject Matter Expert in Medi-Cal billing and policy
- Monitoring Contact Center performance levels, identifying training needs, and developing action plans for staff development
- Serving as state Point of Contact for the Child Health and Disability Prevention (CHDP) program
- Researching and resolving complex billing issues for all provider types including Specialty and Health Access Programs
- Familiarity with Claims Adjudication Systems (CAS) reviewing and reprocessing claims as necessary.
Customer Service Rep Inbound PBM Call Center
AdvancePCS
12.1998 - 08.2002
- Managing a high-volume workload within a deadline-driven environment maintaining metrics goals; ATT, NI, and AHT
- Handling high call volume of call inquiries for prescription claims, authorizations and overrides resolving complex issues.
- Completing testing and analyzing system functionality
- Consistently meeting or exceeding inbound call center prescription claims processing requirements
- Mentoring new hires to prepare in joining the team.
Shift Coordinator
Denny’s Restaurant
11.1990 - 12.1998
- Serving as Shift Coordinator overseeing daily operations supervising staff and providing excellent customer service
- Performing product inventory requests placed and received orders
- Creating accounting reports using RAS System and delivered cash deposits
- Training new hires for Hosts, Servers and cooks
- Relieving managers at various locations for their vacations
Education
Diploma -
River City Senior High School
06.1982
Skills
- Time Management
- Goal Oriented
- Analytical
- Organized
- Quality Assurance
- Performance Measurement
- Auditing
- Discretion
- HIPAA Compliance
- Remote Work
- Virtual Teaching
- Outlook
- Word
- Excel
- PowerPoint
- Teams
- SharePoint
- Access
- Project Management
- Six Sigma Yellow Belt
- Trainability
- Written Communication
- Verbal Communication
- Customer Service
- Call Center Standards
- Training
- Coaching
- Mentoring
- Influencing
- Persuasion
- Adaptability
- Critical Listening
- Collaboration
- Leadership
- Employee Management
- Staff Development
- Action Planning
Certification
California Driver’s License, C2731656
Leadership Experience
- Three years’ experience as a natural leader, successfully managing employees with varied styles and cultures; providing clear direction with effective training, coaching, and mentoring.
- Supervising and developing the team overseeing call center daily operations for twenty Representatives.
- Six years of developing and executing training plans for call center agents with Medi-Cal and IHSS accounts for five to thirty agents.
- Monitoring Contact Center performance levels, identifying training needs, and developing action plans for staff development.
- Mentoring staff to achieve call center standard, metrics and KPIs.
- Six Sigma Yellow Belt and Project Management certification.
References
- Mauro Guzman, 619-928-7366, California, Supervisor
- Edylene Derksen, 916-812-5188, California, Quality Assurance Analyst
- Teresa Martone, 916-280-9977, Texas, Customer Service
- Monica Royse, 916-390-9969, Arizona, Quality Assurance Analyst
Communication Skills
- Excellent written and verbal communication skills, with the ability to confidently interact with internal teams and external partners in a professional manner.
- As a Customer Service Representative, providing outstanding verbal communication to clients, providers and members while simultaneously documenting and exceeding call center standards, metric expectations and KPIs with high quality work.
- As a Quality Assurance Analyst, providing excellent verbal and written communication, training, coaching, and mentoring call center agents in a respectful way while promoting improvement, growth, and encouragement.
- Having the ability to influence or persuade others under positive or negative circumstances.
- Adapting to different styles. Listening critically and collaborating with individuals and groups.
- Communicating with supervisors, and senior leadership via telephone, email and on virtual platforms to elaborate on expectations and progress of agents in the fast-paced call center environment.
Timeline
Customer Experience Associate II
Magellan Health
06.2023 - 12.2025
Life Insurance Agent
American Income Life
02.2022 - 01.2023
Caregiver
In-Home Supportive Services (IHSS)
05.2021 - 08.2023
Quality Assurance Analyst
TriWest Healthcare Alliance
04.2016 - 11.2020
Patient Service Representative
TriWest Healthcare Alliance
03.2016 - 04.2016
Patient Service Representative
Aerotek
10.2015 - 03.2016
Supervisor
Centene
06.2014 - 05.2015
Business Analyst
HP Enterprise Services
01.2012 - 04.2014
Trainer & Quality Assurance Analyst
HP Enterprise Services
08.2006 - 11.2011
Customer Service Rep Inbound PBM Call Center
AdvancePCS
12.1998 - 08.2002
Shift Coordinator
Denny’s Restaurant
11.1990 - 12.1998
Diploma -
River City Senior High School