MARIAJOSE (MJ) ORTEGA
Nashville,TN
Summary
Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Overview
11
11
years of professional experience
Work History
JR. Account Executive / Brand Ambassador
ZEAL Marketing Firm
10.2025 - Current
- Developed tailored marketing strategies to enhance donor engagement and high Revenue for client.
- Setting up promotional Events, Spreading awareness and communicating with 100 + people daily.
- Developed strong relationships with clients, leading to increased trust and repeat business.
- Identified opportunities for upselling services to existing clients, resulting in additional revenue generation.
- Organized meetings between clients and internal teams, facilitating clear communication for project success.
- Participated in daily/weekly team meetings to discuss ongoing projects and strategize improvements for better client outcomes.
- Successfully managed team expectations by setting realistic goals and providing regular updates on progress towards achieving them.
- Built relationships with customers and community to promote long term business growth.
- Gained customer trust and confidence by demonstrating compelling, persuasive and composed professional demeanor.
- Led cross-functional teams to enhance operational efficiency and streamline workflows.
- Oversaw inventory management, optimizing stock levels, and reducing waste.
Member Experience Advisor
NationsBenefits
08.2022 - 05.2023
- Managed and serviced benefit accounts and grievances for 40+ health plans, ensuring accurate rendering of member services. Scheduled appointments with contracted provider offices to support member needs. Provided in-depth advice on hearing loss solutions, OTC benefits, vision, dental, fitness, and life alert equipment. Administered subsidy program benefits with a focus on empathy and effective sales rebuttals to address member objections. Handled 50+ calls per shift with confidence, delivering exceptional customer service.
Medicaid Eligibility Specialist/Case Management II (Bilingual)
Automated Health Systems
12.2020 - 07.2021
- Assessed and coordinated care for TennCare applicants and dual-eligible members by evaluating health, demographic, income, and citizenship/immigration status data, managing 60+ calls daily with excellent customer service reviews. Determined eligibility for Medicaid by verifying prerequisites, income levels, and citizenship status, while providing expertise on Medicare coverages (e.g., QMB, LSMB, QII) for dual-eligible members. Managed case data with accurate data entry for new and existing cases, ensuring HIPAA-compliant documentation of family status, financial circumstances, and health conditions. Adhered to policies by maintaining up-to-date knowledge of TennCare and Medicare procedures, utilizing multiple systems, plugins, and applications to process cases efficiently. Resolved issues and advocated for members by interceding on their behalf, directing them to appropriate resources (e.g., Medicare, SSA, MCOs for health/dental needs), and delivering clear, bilingual solutions to enhance their healthcare experience.
Provider Claims Representative (Bilingual)
Teleperformance
05.2019 - 01.2020
- Performed administrative tasks, including client communication, document scanning, and mail distribution. Processed and verified medical claims, including a detailed claim verification process to ensure accuracy of patient data, procedure codes (CPT, ICD-9/10, HCPCS), and billing details, while calculating adjustments, premiums, and refunds. Managed 60+ daily calls, providing updates on verification/authorization statuses to providers and departments. Ensured HIPAA compliance by maintaining confidentiality of patient records and finances, and conducted fraud detection by monitoring and following up on potentially fraudulent claims, escalating issues as needed. Reviewed provider coding to report services accurately and collaborated with multiple departments to facilitate decision-making for patient admissions and coverage approvals.
Lead Bilingual Customer Service Representative
Lowes Home Improvement
07.2016 - 02.2017
- Leveraged cultural knowledge to resolve customer issues, improving satisfaction ratings through timely solutions. Trained new staff on company policies, monitored team productivity, and balanced workloads to meet objectives. Managed customer account updates for 20+ clients daily and explained 30+ special order options to guide purchasing decisions. Escalated complex issues to supervisors and maintained control over call conversations using scripts.
Lead Front-End Customer Service Associate
Lowe’s Home Improvement
11.2015 - 07.2016
- Led customer service operations by resolving inquiries, processing exchanges/returns, and leveraging bilingual skills to assist diverse customers, enhancing satisfaction and loyalty. Mentored and trained team by onboarding new hires on POS systems and customer service protocols, developing training materials, and evaluating interactions to improve performance. Oversaw transactions and operations, database, reconciling cash drawers, and reviewing invoices for accuracy and compliance. Coordinated deliveries worth $40,000–$60,000 annually, ensuring accurate scheduling and documentation to support seamless operations. Supported loss prevention by monitoring transactions, maintaining accurate drawers, and ensuring adherence to company policies and safety regulations. Collaborated strategically with sales teams and leadership to boost revenue, develop promotional strategies, and submit reports to inform corporate initiatives.
Retail Sales Manager
Street Dreams Co
02.2015 - 11.2015
- Drove sales and revenue by developing merchandising and promotional strategies, analyzing sales reports to identify trends, and using consultative sales approaches to boost customer engagement and meet targets.
- Led and trained team by recruiting, interviewing, and coaching staff on sales techniques and product knowledge, improving performance and maintaining high team morale.
- Enhanced customer experience by providing hands-on assistance, resolving complaints and leveraging bilingual skills to guide purchasing decisions, fostering loyalty.
- Managed inventory and merchandising by overseeing stock levels, maintaining visual merchandising standards, and coordinating promotional displays and in-store demonstrations.
Education
Bachelors in Applied Business - Business Administration and Management
San Antonio College
Walnut, CA05-2016
GED -
Mount San Antonio College
Walnut, CA06.2012
Skills
- Deal closing
- Sales strategy development
- Customer service
- Goals and performance
- Relationship building and management
- Staff management
- Operations
- Account planning
- Project management
- Attention to detail
- Decision-making
- Office administration
- Data confidentiality
- Personable and approachable
- Schedule coordination
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Hebrew
Professional Working
Timeline
JR. Account Executive / Brand Ambassador
ZEAL Marketing Firm
10.2025 - Current
Member Experience Advisor
NationsBenefits
08.2022 - 05.2023
Medicaid Eligibility Specialist/Case Management II (Bilingual)
Automated Health Systems
12.2020 - 07.2021
Provider Claims Representative (Bilingual)
Teleperformance
05.2019 - 01.2020
Lead Bilingual Customer Service Representative
Lowes Home Improvement
07.2016 - 02.2017
Lead Front-End Customer Service Associate
Lowe’s Home Improvement
11.2015 - 07.2016
Retail Sales Manager
Street Dreams Co
02.2015 - 11.2015
Bachelors in Applied Business - Business Administration and Management
San Antonio College
GED -
Mount San Antonio College