Maricela Garcia
Detroit,MI
Summary
Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Overview
18
18
years of professional experience
Work History
Internal Corporate Audit & Advisory Services
Delta Dental of Michigan
09.2021 - 08.2025
- Performed internal audits to assess risk, identify errors, and recommend corrective action improvements.
- Supported process improvement initiatives by identifying operational gaps and recommending workflow enhancements.
- Worked effectively in fast-paced environments.
- Self-motivated, with a strong sense of personal responsibility.
- Collaborated with cross-department teams to strengthen claims integrity and support compliance reviews.
- Analyzed claim trends, discrepancies, and billing patterns to detect potential fraud, waste, or abuse.
- Ensured documentation accuracy and supported audit reporting requirements.
- Audit credentialing files to ensure regulatory compliance and identify discrepancies
Quality Control Specialist
Delta Dental of Michigan
01.2019 - 01.2021
- Conducted call monitoring and quality scoring to assess service performance.
- Completed quality assurance audits to ensure adherence to organizational and regulatory standards.
- Provided coaching and feedback to team members to improve service and accuracy.
- Maintained strict compliance with HIPAA and privacy regulations.
- Applied dental and medical claims knowledge to review benefit accuracy.
- Performed root cause analysis to address recurring errors and support process improvements.
- Developed documentation, reports, and QA summaries to support leadership review.
Customer Service Specialist
Delta Dental of Michigan
01.2017 - 01.2019
- Handled high-volume inbound calls with professionalism and accuracy.
- Assisted members with billing inquiries, benefits clarification, and account support.
- Utilized strong conflict-resolution and de-escalation skills to resolve member concerns effectively.
- Active Listening & Empathy
- Clear Verbal & Written Communication
- Problem Solving & Critical Thinking
- Rapport Building & Member Engagement
- Time Management & Multitasking
Office Support & Dental/Medical Billing Specialist
Kazangy Medical Dental
01.2008 - 01.2017
- Managed claims processing, prior authorizations, and billing for medical and dental services.
- Coordinated provider credentialing, treatment plans, patient scheduling, and payroll functions.
- Maintained communication with vendors, insurance carriers, and patients to ensure smooth office operations.
- Performed both front and back-office duties, ensuring accurate documentation and reporting.
- Provided chairside support as a dental assistant when needed.
Education
Associates of Applied Business (AAB) -
Henry Ford Community College
Dearborn, MI01.2017
High School Diploma - undefined
Chadsey High School
Detroit, MI01.2008
Skills
- Remote/Hybrid Work Experience (7 years)
- Customer Service experience (4years)
- Active Listening & Rapport Building
- Clear, Professional Communication
- Privacy Controls Testing & Evaluation
- Fraud, Waste & Abuse (FWA) Identification
- Data Entry Accuracy & Trend Analysis
- Claims Review for Accuracy & Compliance
- Documentation, Compliance & Process Improvement
- Claims Auditing & Error Identification (4 years)
- Microsoft Office Suite (12 years)
- Independent Work Capability in High-Volume Environments
- Bilingual: Spanish (Fluent verbal/written)
- Customer service
- Problem-solving
- Time management
- Flexible and adaptable
- Multitasking
- Teamwork and collaboration
Languages
Spanish
Native or Bilingual
Timeline
Internal Corporate Audit & Advisory Services
Delta Dental of Michigan
09.2021 - 08.2025
Quality Control Specialist
Delta Dental of Michigan
01.2019 - 01.2021
Customer Service Specialist
Delta Dental of Michigan
01.2017 - 01.2019
Office Support & Dental/Medical Billing Specialist
Kazangy Medical Dental
01.2008 - 01.2017
High School Diploma - undefined
Chadsey High School
Associates of Applied Business (AAB) -
Henry Ford Community College