Laura Zendejas
Arleta,CA
Summary
Dynamic Appeals and Grievances Coordinator at MedPOINT Management with a proven track record in dispute resolution and process improvement. Expert in analyzing appeals documentation and enhancing workflows, while fostering collaboration across teams. Recognized for meticulous attention to detail and effective communication, driving successful outcomes in member grievances and compliance.
Professional service representative ready to bring expertise in customer support and issue resolution. Skilled in communication, problem-solving, and maintaining high standards in fast-paced environments. Strong focus on team collaboration and adapting to changing needs. Known for reliability and achieving results through effective teamwork and attention to detail.
Overview
10
10
years of professional experience
Work History
Appeals and Grievances Coordinator
MedPOINT Management
08.2020 - Current
- Coordinated resolution of member grievances to ensure compliance with regulatory guidelines.
- Analyzed appeals documentation to identify trends and recommend process improvements.
- Collaborated with cross-functional teams to streamline grievance processing workflows.
- Developed training materials for staff on appeals and grievances procedures and best practices.
- Demonstrated high-level attention to detail when reviewing medical records, provider contracts, and other relevant documents during case assessments.
- Facilitated communication between members, providers, and internal departments to resolve disputes efficiently.
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
Group Service Representative
Health Net
04.2016 - 06.2020
- Assisted Account Managers in the coordination and organization of renewal activities
- Coordinated open enrollment processes and wellness activities, by collaborating with internal and external partners
- Ensured implementation of renewals by monitoring related processes
- Prepared requests for open enrollment materials, reviewed new business group quote request forms, group renewal request forms, and enrollment packets.
- Verified documents for accuracy and follow-up to obtain accurate and/or missing information
- Participated and attended health fairs and open enrollment meetings
- Assisted in the resolution of issues presented by brokers, clients, and members
- Responded to phone and e-mail inquiries from internal and external customers in response to sales/service questions and/or issues
- Completed Group Sales Notifications (GSN's) input, processing, and tracking; followed up if necessary, with the appropriate departments to ensure internal implementation
- Prepared and processed service agreement requests for approval by Account Managers
- Tracked information and entered data into various Health Net systems
- Completed literature and marketing communication requests for new collateral through established tracking procedures
Education
High School Diploma -
Van Nuys High School
Van Nuys, CASkills
- Dispute resolution
- Multitasking Abilities
- Problem-solving
- Time management
- Teamwork and collaboration
- Attention to detail
- Problem-solving abilities
- Verbal and written communication
- Relationship building
Accomplishments
- Collaborated with a team of 26 in the development of grievance resolutions
- Achieved relationships with insurance carriers by completing complex resolution strategies with accuracy and efficiency
- Achieved better client relationships by taking on the more demanding carriers in order to meet expectations
Languages
Spanish
Native or Bilingual
Timeline
Appeals and Grievances Coordinator
MedPOINT Management
08.2020 - Current
Group Service Representative
Health Net
04.2016 - 06.2020
High School Diploma -
Van Nuys High School