Mahali Cruz Hernandez

• Managed high-volume calls across Employer, Directed Spend, and Employer COBRA insurance.
• Assisted members with food card orders, utilities payments, and benefit card discrepancies.
• Processed payments and improved first-call resolution.
• Supported COBRA participants with portal support, elections, and benefit walkthrough.

• Answer 30–40 inbound/outbound calls daily, delivering compassionate, accurate, and timely support.
• Resolve escalated concerns by researching complex issues across multiple databases.
• Provide detailed explanations of benefits, eligibility, and coding accuracy.
• Perform authorization and appeals analysis following HIPAA guidelines.
• Serve as Team Ambassador, functioning as an informal advocate.
• Navigate multiple systems, transitioning across platforms quickly.
• Support performance goals in first call resolution, quality, efficiency, and customer satisfaction.

Member Advocate

• Led a team of 23 representatives, managing escalations and protocol compliance.
• Managed incoming and outbound calls to Medicare and Medicaid recipients.
• Educated members on available benefits and services.
• Scheduled health risk assessments to support preventive care.
• Assisted individuals with housing, food resources, and home medical support services.

Illinois Department of Employment Security| Team lead CSR

• Managed unemployment claim calls and demographic updates.
• Responding to inquiries about claim status, eligibility, payment details, and general program rules.