Jennifer Gomez
Palmdale
Summary
Dedicated healthcare operations professional with 15+ years of experience in eligibility, enrollment, referral management, appointment scheduling, and member/provider relations. Proven expertise in streamlining processes, resolving escalations, and ensuring compliance with Medicare, Medicaid, and commercial health plan regulations. Recognized for accuracy, attention to detail, and ability to thrive in high-volume, deadline-driven environments. Bilingual in English and Spanish.
Overview
20
20
years of professional experience
Work History
Referral Specialist
Centene/ Healthnet
Woodland Hills, California
06.2015 - 09.2025
- Manage inpatient hospital notifications, ensuring accuracy and compliance in multiple medical management systems.
- Conduct telephonic outreach to providers and members to coordinate care and verify case details.
- Support clinical teams by routing cases to appropriate reviewers (UMC, RN).
- Perform non-clinical claim reviews, and document findings to support medical management functions.
- Serve as a liaison between members, providers, and Health Net to resolve escalations and improve service outcomes.
Medicare Outreach Specialist
Centene/ Healthent
Woodland Hills, California
03.2014 - 06.2015
- Perform outbound calls to engage patients of practices and health systems in a discussion about the benefits of HealthNet, the Medicare program, and tech-enabled services.
- The follow-up care plan for members needs to include scheduling appointments or enrolling members in programs.
- Conducted surveys to gather feedback on community health services and programs offered.
Eligibility Representative III (Team Auditor)
Centene/ Healthnet
Woodland Hills, California
07.2009 - 03.2014
- Audited enrollments, disenrollments, and member communications across Medicare Supplement, Employer Group, COB/PDP, and MA/MAPD lines of business, maintaining 98%+ accuracy.
- Trained and supported team members on proper enrollment processing and compliance procedures.
- Resolved escalated enrollment issues, and managed discrepancy reports to ensure timely resolution.
Eligibility Representative I/II
Centene / Healthnet
Woodland Hills, California
03.2006 - 07.2009
- Processed Medicare Supplement, Employer Group, and COB/PDP enrollments while ensuring strict adherence to regulatory compliance timelines.
- Handled escalated issues from members, providers, and account representatives.
- Researched and resolved discrepancies, improving the accuracy of eligibility records.
- Coordinated provider and member outreach to clarify and resolve enrollment-related concerns.
Document Control Technician
Centene/ Healthnet
Woodland Hills, California
09.2005 - 03.2006
- Archived, scanned, and maintained accurate member correspondence records.
- Processed return mail and updated contact information in Health Net systems.
- Assisted with departmental projects to support compliance and operational efficiency.
Education
Dental Assistant -
Concorde Career College
North Hollywood, CA06-2004
High School Diploma -
First Lutheran High School
Sylmar, CA06-2003
Some College (No Degree) -
Los Angeles Valley College
Van Nuys, CASkills
- Medical management
- Telephonic outreach
- Claim documentation
- Compliance auditing
- Enrollment processing
- Care coordination
- Insurance verification
Languages
Spanish
Native/ Bilingual
References
References available upon request.
Timeline
Referral Specialist
Centene/ Healthnet
06.2015 - 09.2025
Medicare Outreach Specialist
Centene/ Healthent
03.2014 - 06.2015
Eligibility Representative III (Team Auditor)
Centene/ Healthnet
07.2009 - 03.2014
Eligibility Representative I/II
Centene / Healthnet
03.2006 - 07.2009
Document Control Technician
Centene/ Healthnet
09.2005 - 03.2006
Dental Assistant -
Concorde Career College
High School Diploma -
First Lutheran High School
Some College (No Degree) -
Los Angeles Valley College
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