Jenny Morales
La Mirada,Ca
Summary
Maintain a positive attitude, as evidence by business partner feedback; promote work environment, demonstrate by good interpersonal relations with team members, positive attitude and bring suggestions for resolutions. Work in an environment where I may perform and share the skills I have learned to a team and ensure that the organization is in compliance with all regulations, laws, and policies. I am a very motivated and devoted individual who is ready to focus on building towards assigned responsibilities making sure departmental and organizational goals are met.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Delegation Oversight Specialist
OptumCare Management
11.2018 - Current
- Provide support often to people who perform specific tasks alone as part of a greater team effort to aid for knowledge, aid due to timeliness, aid for improvement for self and team goal
- Responsibilities currently consist of a mixture of UM delegation oversight reporting, regulatory adherence coordination for reporting and care management responsibilities
- Leveraging a broader team is a win, demonstrate to be sensitive to the need for help and support for tasks in need to be accomplished, very easily switch and prioritize tasks based on the bandwith and required tasks and deadlines
- Work well with timelines, deadlines and multiple deliverables
- Knowledge in change of business models and workflows demonstrated through familiarity of health plans, policies/procedures of various departments
- SME in the action of presenting, driving and speaking to internal and external quality and regulatory data validation compliance audits/ auditors/nurses when performance evaluations and monitoring of corrective actions for CMS, DMHC requests are required
- Taken the lead role in training peers via screen sharing and cross training peers for multiple health plan reporting, health plans requirements, cadences for monthly, quarterly, ad - hoc, annual and semi-annual reporting as well as HICE Work Plans for all lines of business and multiple CDOs while keeping my own responsibilities afloat
- Assist in developing and maintaining job aids, processes for a variety of projects and reporting needs to ensure consistent, efficient, and compliant regulatory processes are followed
- Compiling data and producing reports and metrics for various compliance and committee reporting when needed
- Well versed in many types of reporting requests
- Understand goals, priorities and plans by communicating to applicable contacts and share points without deviation in progress or needed corrections on a regular basis
- Took a standing platform role in the transition to a new system CURO that required me to present and help my new colleagues how to use it for reporting and understanding of aligning reports (with the help of IT) for supporting innovation and creativity by working endlessly with the technical team to ensure the compliance reports are mapped correctly for all line of businesses and 22 CDO/health plans
- Work closely amongst colleagues within the team when health plans transition or make large changes for multiple lines of business. Attention to detail and follow up is very important, asking questions and preparing has become a process in the everyday life of my role.
- Worked to ensure the HRA and PPG gaining and transferring members packets were processed correctly and that case managers were being assigned and worked on accordingly
- Very knowledgeable with various referral and data systems
- To name a few CCT, IDX, Care Director, Care in Motion, ERA, Citrix, and now currently learning other CDO systems that are aligning into one
- Great source of information for staff that is new and oncoming to our department that is growing very quickly. Providing primary contact info and constantly delivering information quickly and correctly is utmost important when we want to move ahead together in unison
- Responsible for working with third party vendor to gather and preparing specialist provider termination letter mailings and keeping record via a log for 13 health plans
- Frequently collaborate with cross-functional teams to achieve project goals on time and completely.
- Led cross-functional team to produce reports for health plans that are using a new system to better organize the data flow for care management
- Improved team collaboration by initiating regular strategy meetings.
- Increased efficiency by up keeping routine/non routine tasks with software solutions such as teams documentation of grids and apps.
- Helped meet changing demands by recommending improvements to business systems or procedures.
- Maintained database systems to track and analyze operational reporting data using quick base software
- Educated staff on organizational mission and goals to help employees achieve success.
- Cultivate positive relationships with vendors and health plans to deliver timely and diligent services and material provided.
Senior Fraud Claim Analyst
Bank of America
01.2016 - 08.2018
- 3year experience in strong volume call center
- Answered customers basic inquiries related to balances with accuracy
- Successfully met metrics with efficiency and excellent quality
- Received great results by the voice of the costumer survey month to month
- Promoted to check fraud claims analyst due to my personal interest and application
- Trained to deescalate and solve complex fraud monetary situations while maintaining positive and calm for the costumer
- Subject matter expert in check fraud and online banking fraud claim initiation and fraud investigation
- Experience in check, ACH, Debit card, and Wire (International and Domestic fraud investigations)
- Subject matter expert in Online Banking
- Subject matter expert for non-fraud claims and recovery protocols
- Subject matter expert in OFAC - Office of foreign assets control request and protocols
- Develop and implement effective strategies useful in addressing fraud
- Maintain current knowledge of trends in financial maneuvers as well as current techniques employed in detecting fraudulent operations
- Effectively probe for detailed information to ensure true fraud is report
- Received several certificates of recognition for providing customer delight
- Work efficiently and responsibly with numbers and balances and personal information
- Month to month excellent quality reviews in accordance with bank guidelines, policy, and law regulations
- Responsible for mitigating losses effectively
- Have personally mitigated losses and recovered over 1 million dollars for small business for personal checking and savings accounts
- Work directly with surrounding fraud detection and risk department to resolve cases
- Relay difficult message with empathy and respect to victims of fraud or victims of scams
Premier Credit Card Customer Service Specialist
Bank of America
01.2015 - 01.2016
- Managed high call volume while maintaining a courteous and professional demeanor.
- Answered customers basic inquiries related to balances with accuracy
- Experience in providing best assistance and maintenance to customers’ large accounts
- Subject matter expert for all credit cards accounts while providing customer delight and medium experience in sales
- Recognition received for providing excellent services and going above and beyond for all customers
- Handled escalated calls calmly, finding resolutions that satisfied both the company and the customer''s needs.
- Enhanced customer satisfaction by resolving issues promptly and professionally.
Utilization Review Administrator
Southern California Mental Health Center and Associates
11.2013 - 01.2015
- Maintained accurate documentation of company policies and procedures for easy reference by all employees
- Promoted to utilization review administrator to keep up to date with workers compensation laws passed as of 2006 by governor
- Responsible for keeping current with HIPPA and regulations
- Served as a liaison between departments, fostering open communication channels that improved overall organizational function.
- Managed human resources functions, including hiring, onboarding, and employee evaluations for optimal team performance.
- Coordinated company events and meetings to foster teamwork and boost employee morale.
- Responsible for working close with the patient, doctor, attorney and insurance companies to keep track of each patient treatment requests and approvals
- Responsible for filing, bookkeeping and addressing any issue per case
- Articulately and promptly enter daily data, format letters and answer calls to answer questions regarding insurance eligibility and treatment approved by multiple insurance adjusters
- High volume of communication from attorneys and medical providers such as orthopedic offices, sleep study centers and other facilities referring and requesting their patients to this psychiatric facility to obtain the help the patient needs
Biofeedback Technician, Educator
Southern California Mental Health Center and Associates
05.2006 - 01.2015
- Directly work with people who actively hold a workers compensation claim for reported job injury
- Detailed interpretative research and critical analysis of psychological tests and ongoing recovery goal documentation
- Offer support, affirmation and encouragement support system for individuals who are emotionally unstable diagnosed with depression, bipolar, anxiety, panic attacks, chronic pain, insomnia, and other emotional/psychological disorders
- Train individuals to improve their health by education of controlling certain mental, bodily and emotional processes that normally occur when psychological and physiological imbalances exist
- Provide education and relaxation coaching when existing respiration, heart rate, blood circulation, high blood pressure readings, headaches, muscle tension, hyperventilation, anxiety or panic attacks, stress, changes in body temperature and chronic or acute pain thru biofeedback training and techniques
- Provide biofeedback therapy under direct supervision by psychiatric medical board director Jerome H Terpperman, MD and Alfred M Bloch. MD.
- Trained new technicians on standard operating procedures, ensuring consistency across the team.
Education
Psychology -
California State University, Los Angeles
01.2007
California State University, San Francisco
01.2006
Skills
- Reporting Communication
- Procedural Knowledge
- MS Excel
- MS Word
- Critical Thinking
- Detail Oriented
- Organizational Skills
- Results Driven
- Team building
- Quality Assurance
- Multitasking
- Team performance improvement
- Problem-solving aptitude
- Audit reporting
- Resource Allocation
- Professionalism
- Time management abilities
- Adaptability
- Project Management
- Workflow Optimization
- Regulatory Compliance
- Cross-functional team leadership
Certification
- Certificate of Biofeedback Technician
- Optum Award
Affiliations
Bank of America – HOLA Hispanic/Latino Organization for Leadership & Advancement
Recognition Award - Date 06/15/2022
Received an award for exceptional job performance and continuous teamwork to build new structural processes within UM Compliance
Timeline
Delegation Oversight Specialist
OptumCare Management
11.2018 - Current
Senior Fraud Claim Analyst
Bank of America
01.2016 - 08.2018
Premier Credit Card Customer Service Specialist
Bank of America
01.2015 - 01.2016
Utilization Review Administrator
Southern California Mental Health Center and Associates
11.2013 - 01.2015
Biofeedback Technician, Educator
Southern California Mental Health Center and Associates
05.2006 - 01.2015
California State University, San Francisco
Psychology -
California State University, Los Angeles