Jenea Gutierrez
San Antonio,Texas
Overview
10
10
years of professional experience
Work History
Senior Analyst-Medicare Expert (State of North Carolina)
Aetna/CVS Medicare/Commercial
06.2025 - Current
- Process Daily Medicare Primacy Report for the client to correct any discrepancies
- Assist Eligibility Consultants with all Medicare inquires to ensure Aetna database coincides with Client Database to avoid daily fallout
- Assisted in monthly audits solely concentrated on the Medicare portion
- Update Rumba MEA system COB information to coincide with CMS
Eligibility Consultant-Electronic Ops
Aetna/CVS Medicare
09.2022 - 06.2025
- Cross Trained on PDP Platforms
- Maintained enrollment databases and coordinates transfer of non-electronic eligibility data.
- Responded, researched, and resolved eligibility and/or billing related issues involving member specific information.
- Validated benefit plan enrollment information for assigned clients for accuracy and completeness.
- Coordinated the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
- Completed data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
- Reviewed and corrected transaction errors impacting eligibility interfaces and prepares eligibility/enrollment for imaging.
- Interpreted and translated client benefits and supporting account structure against internal systems/applications
- Applied all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
- Assisted colleagues with special projects with time sensitivity
- Crossed trained on the PDP platform for enrollment and eligibility for Federal groups
- Assisted with the Federal/Postal implementation project
Senior Service Advocate
Aetna/CVS Medicare
05.2018 - 09.2022
- Cross trained on all platforms of ASD, GPS & Coventry/IDX
- Mentor line- assisted with customer service representative questions and concerns on work policies and workflows. Sent coaching and kudos to representatives to perfect customer experience.
- Cross trained in Access to Care – De-escalated member issues such as loss of entitlement, Precertification, out of network providers with an in-network exception.
- Task Team - Executed follow up calls to providers, claim reworks, confirming items needing re-prints and mail outs. Completed courtesy calls to the member regarding escalation issues while sending coaching to reps.
- CTMs Escalations – Verified daily CTMs received and performed audits to perfect customer satisfaction along with areas needing updated workflows. Generating reports via MEDHOK
- Task returns- Initiated returns from outside departments (Billing, Enrollment & Claims) Completed missing information or needing more information or notes that are unclear along with sending coaching to reps. Orchestrated Aetna Medicare Member Materials Training
- Orchestrated in generating all member correspondence to be sent in forms of Email, Faxes and Mailings.
- Generated correspondence being requested by member.
Customer Service Rep
Aetna Medicare
09.2015 - 05.2018
- Cross Trained: IDX, HMO, MP and GPS
- Answered questions and resolved issues in regard to plan sponsors, PSS/IOS, members and providers.
- Provided customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.
- Educated and assisted customer on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company.
- Utilized all relevant information to effectively influence member engagement.
- Resolved issues without or with limited management intervention.
- Provided education to member to support them in managing their health.
- Provided Claim status information, benefit coverage interpretations and explaining plan eligibility
- Processed claim referrals, new claim hand-offs, and escalated issues as appropriate through the system for grievance and appeals.
- Initiated out-reach/welcome calls to ensure expectations are met or exceeded
- Accepted premium inquires/payments for members to ensure no break in coverage
- Included with the MP and GPS pilot initiation to ensure systems were user friendly along with searching for any errors/bugs.
Education
Bachelor of Business Administration - undefined
University of Texas at San Antonio
San Antonio, Texas05.2023
Skills
- Team leadership
- Communication proficiency
- Multitasking and analytical skills
- Organizational expertise
- Microsoft Office proficiency
- Time optimization
- Empathetic listening
- Decisive action
- Adaptability to change
- Critical analysis
Timeline
Senior Analyst-Medicare Expert (State of North Carolina)
Aetna/CVS Medicare/Commercial
06.2025 - Current
Eligibility Consultant-Electronic Ops
Aetna/CVS Medicare
09.2022 - 06.2025
Senior Service Advocate
Aetna/CVS Medicare
05.2018 - 09.2022
Customer Service Rep
Aetna Medicare
09.2015 - 05.2018
Bachelor of Business Administration - undefined
University of Texas at San Antonio