JULISSA TRUJILLO MALDONADO
Carolina,PR
Summary
Dynamic Operations Leader with over 5 years of progressive leadership experience in healthcare and insurance industries. Demonstrated expertise in driving operational efficiency, enhancing performance metrics, streamline processes. Proven success in leading and developing high performance teams, implementing expandable solutions, and aligning business strategies with organizational goals with a strong background developing future leaders and creating long lasting client relationships by fostering communication and optimizing productivity. Currently advancing a Bachelor's degree in Phycology with focus on organizational leadership, communication and management.
Overview
6
6
years of professional experience
Work History
Associate Manager
Carelon (Elevance Health)
03.2024 - Current
- Manage caller interactions with professionalism, ensuring de-escalation and resolution.
- Served as client liaison overseeing workforce metrics and strategic initiatives.
- Partnered on business reviews by updating performance data and recommending process improvements directly with Stake Holders.
- Directed onboarding and operations for 30+ employees, achieving 100% throughput.
- Designed and assigned work strategies aligned to team strengths and business priorities.
- Recruited and interviewed 150+ candidates, selecting high-potential talent.
- Represented the company at job fairs to strengthen recruitment and employer branding.
- Facilitated brainstorming and training timeline planning to promote cross-training.
- Resolved employee concerns, administered corrective actions, and promoted positive engagement.
- Delivered targeted coaching to identify and address training needs.
- Created action plans to enhance productivity, efficiency, and quality.
Customer Service Supervisor
Optum
01.2023 - 03.2024
- Directed daily operations ensuring service quality, adherence, and turnaround time compliance.
- Established team priorities and guided staff to achieve departmental objectives.
- Coordinated workflows across managers, supervisors, and cross-functional units.
- Delivered coaching, performance evaluations, and corrective actions to improve results.
- Acted as subject matter expert and trainer for quality auditors.
- Identified and addressed operational challenges with structured problem-solving.
- Ensured accountability for output while maintaining alignment with business goals.
Customer Service Team Lead
Optum
11.2022 - 01.2023
- Resolved escalated issues and supported agents through floor and chat assistance.
- Evaluated customer interactions for NPS scoring and provided feedback.
- Conducted refresher training for returning agents or those needing additional support.
- Delivered onboarding training for new agents and team leads.
- Collaborated with workforce management to monitor AHT and optimize scheduling.
Coordination of Benefits Representative
Humana
07.2021 - 11.2022
- Gathered and validated coordination of benefits (COB) data from providers, members, and insurers.
- Executed administrative and operational tasks independently with minimal supervision.
- Applied organizational policies to resolve COB discrepancies with accuracy.
- Leveraged CRM, CAS, Mentor, ECRS, RX Nova, and other systems for COB management.
- Consolidated COB information ensuring accuracy of reporting and claims processing.
Claims Research and Resolution
Humana
01.2020 - 07.2021
- Investigated and resolved claims-related issues with providers, insurers, and members.
- Approved claim settlements within company guidelines.
- Processed CMS 1500 and UB-04 forms, applying CPT-4, ICD-9, ICD-10, and HCPCS coding systems.
- Navigated CAS, E-Hub, CGX 2.0, Macess, and Mentor platforms to support claim resolution.
- Delivered accurate and timely resolutions while meeting compliance standards.
Education
Bachelor of Arts - Psychology
Ana G Mendez
01.2026
Skills
- Operational Leadership & Team Management
- Business Planning & Performance Metrics
- Employee Development & Coaching
- Customer Experience Management
- Process Improvement & Quality Assurance
- Conflict Resolution & Problem Solving
- Training & Mentorship
- Strategic Planning & Organizational Growth
LANGUAGES
English (Fluent)
Timeline
Associate Manager
Carelon (Elevance Health)
03.2024 - Current
Customer Service Supervisor
Optum
01.2023 - 03.2024
Customer Service Team Lead
Optum
11.2022 - 01.2023
Coordination of Benefits Representative
Humana
07.2021 - 11.2022
Claims Research and Resolution
Humana
01.2020 - 07.2021
Bachelor of Arts - Psychology
Ana G Mendez