Jacqueline Marquez
Colorado Springs,CO
Summary
Stellar performing professional with 23 years of experience delivering high-impact work in a service industry. Skilled in developing internal and external relationships to facilitate collaborative achievement of high priority goals. Confident in ability to thrive in a fast – paced setting and leverage skills in networking, coaching, and mentorship to enable team success. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Service Escalations Account Manager
Optum
Colorado Springs
08.2023 - Current
- Handle and resolve escalated member issues in a timely manner
- Act as point of contact for complex cases, enrollment issues, working closely with cross-functional teams to ensure resolution and member satisfaction
- Receive and research member concerns, understanding root cause and develop solutions
- Coordinate with internal teams: Collaborate with various department, including WTW, OptumRx, Claims, and Optum Financial to name few
- Provide exceptional customer service: Ensure high level of member satisfaction by actively listening to concerns, empathizing with their situation, and providing effective solutions
- Analyze and resolve complex problems: Develop creative and practical solutions to meet member needs, outside of benefits education while considering company policies and procedures
- Maintain accurate records: Document all customer interactions, resolutions, and any follow up actions to be taken, ensuring accurate and up to date records are maintained
- Communicate with members: Keep them informed about progress of escalated cases and follow up tasks
- Provide regular updates ensuring clear, concise, and simple words throughout resolution process
- Handle challenging situations: Remain calm and professional when dealing with difficult or upset callers, demonstrating strong conflict resolution skills, and ability to de-escalate tense situations
- Stay updated on product knowledge to effectively address member concerns and provide accurate information
- Strive to meet or exceed performance targets such as response time, resolution time, and member NPS score.
SDOH A4ME Sr
United Healthcare, UHG
Remote
02.2021 - 08.2023
- Provide phone support to drive resolution of caller questions/issues
- Single POC for all of member’s health care needs
- Provide expertise and customer service support to members as part of UnitedHealthcare Advocate4Me model
- Direct phone-based customer interaction to address complex member needs and provide recommendations on services that may help close gaps in care for member and/or member’s family
- May authorize claims payments or refer claims to investigators for further review pain points
- Work independently, mentor others, act as resource for team
- Apply knowledge/skills to complex activities
- Provide community-based organization resources to members
- Demonstrate depth and breadth of knowledge/skills in own area and is often able to apply these outside of own function
- Often act as technical resource to others in own function
- Anticipate customer needs and proactively identify solutions
- Solve complex problems on own
- Plan, prioritize, organize, and complete work to meet established objectives
- Act as a facilitator to resolve conflicts on team; seen as key team member on project teams spanning more than owner.
UHC Benefit Ops - Gov't Ops M&R Ops - Consumer Services
United Healthcare, UHG
Remote
04.2019 - 10.2021
- Communicate effectively and clearly with service members and beneficiaries calling in with questions about their benefit plan coverage, co-pays, deductibles, and other parts of their AARP plan
- Answer incoming calls from providers and give status of referrals and authorizations received via fax or website
- Locate and change primary care providers for members
- Answer provider credential issues
- Research par and non-par providers
- Help locate in-network doctors, hospitals, and ancillary offices
- Schedule wellness visits for members
- Address member claims and status
- Submit member-initiated organization determination (MIOD) as needed.
Military & Veterans M&V Call Center Operations
United Healthcare, UHG
Colroado Springs CO
07.2015 - 10.2017
- Communicate effectively and clearly with service members and beneficiaries calling in with questions about their benefit plan coverage, co-pays, deductibles, and other parts of their AARP plan
- Answer incoming calls from providers and give status of referrals and authorizations received via fax or website
- Locate and change primary care providers for members
- Answer provider credential issues
- Research par and non-par providers
- Help locate in-network doctors, hospitals, and ancillary offices
- Schedule wellness visits for members
- Address member claims and status
- Submit member-initiated organization determination (MIOD) as needed.
- Strengthened communication skills through regular interactions with others.
Education
Bachelor of Science - Hotel and Restaurant Management
03.1997
Skills
- New Hire training delivery assistant (10-week M&R DSNP class Jan 30- April 7, 2023)
- Strong administrative skills, good attention to details
- MS Office applications - Outlook, Excel, Teams, PowerPoint, and Word, Qfinity, Iex, Tableau, MyMetrics, DMEVs, CMS ICUE,and GPS proficient
- 65 wpm typing skills
- Reports generation, data analytics, network marketing, social media management, telecommunication, customer service, sales/marketing, and coaching to metrics Certified healthcare bilingual Proficient in Tagalog and English languages
- Possess high level of integrity, collaboration, and confidentiality
- Excellent interpersonal and customer interaction skills
- Strong communication skills, both oral and written in two languages
- Flexible, coachable, willing to learn
- Enjoys working with people, but capable to work as individual or part of a team
- Opportunities Identification
- Relationship building and management
- Client Relations
- Issue Resolution
- Relationship Building
- Client Relationship Management
- Goals and performance
- Goal-Oriented
- Teamwork and Collaboration
Certification
- M&R certified 1, 2 and 3
- EEX Champ
- SDOH Certified
- Licensed Life Insurance agent/producer (in the states of CA, CO, TX, VA and NJ) for National Life Group 2021 to present
- Nurse Aide Training – Avanza Training School May 18-29, 2015 (www.avanzacna.org)
- Certified AHI (Associate Healthcare Interpreter) by the Certification Commission for Healthcare Interpreters
References
- Jessie Zuniga (Supervisor)
- Sarah Moulton (Business Manager)
- Loretta Johnson (Business Manager)
- LaTanya Valdiviez (SR Trainer)
Languages
Tagalog
Full Professional
Timeline
Service Escalations Account Manager - Optum
08.2023 - Current
SDOH A4ME Sr - United Healthcare, UHG
02.2021 - 08.2023
UHC Benefit Ops - Gov't Ops M&R Ops - Consumer Services - United Healthcare, UHG
04.2019 - 10.2021
Military & Veterans M&V Call Center Operations - United Healthcare, UHG
07.2015 - 10.2017
St. Paul College of Manila - Bachelor of Science, Hotel and Restaurant Management