MARITZA ARGUELLO
Winter Springs,FL
Summary
Detail-oriented professional with experience in grievances, case review, documentation evaluation, complaint resolution, and workflow management. Strong ability to assess information, determine appropriate outcomes, and maintain quality, compliance, and timeliness. Skilled in prioritizing high-volume work with minimal supervision, coordinating tasks, and collaborating with clinical and operational teams. Fluent in English and Spanish.
Overview
25
25
years of professional experience
Work History
Independent Contractor
National Insurance Inspection Services
01.2020 - Current
- Review and verify documentation to ensure accuracy before submission.
- Resolve discrepancies through direct client communication and follow-up.
- Maintain detailed case records while managing a high-volume workload independently.
- Prioritize tasks to consistently meet deadlines and quality expectations.
Operations Manager
Great Depths Marine
01.2012 - 01.2020
- Oversaw daily operations and monitored workflow distribution to meet quality and compliance standards.
- Analyzed documentation for accuracy and adherence to international requirements.
- Assigned, tracked, and monitored team workloads to meet productivity goals.
- Adapted quickly to evolving procedures and fast-paced operational changes.
Rental Branch Manager
Enterprise Rent-a-Car
01.2004 - 01.2011
- Managed customer issues and escalations; reviewed information and determined resolutions.
- Maintained case records and ensured accuracy in documentation and reporting.
- Directed scheduling, workflow assignment, and performance expectations for team members.
Patient Relations Manager
Western Dental Services
01.2001 - 01.2003
- Chaired the Grievance Committee; reviewed patient complaints and supporting documentation.
- Issued written determinations and coordinated resolution letters.
- Identified trends in grievances to support process improvements.
- (Highly relevant to Humana’s Grievances & Appeals role.)
Education
B.S. - Marketing & Business Administration
University of Mobile Alabama
Skills
- Grievances & Appeals
- Case Review
- Documentation Analysis
- Determinations
- Compliance
- Quality Standards
- Issue Resolution
- Case Assignment & Tracking
- SLA Adherence
- Workflow Prioritization
- Decision-Making
- Independent Work
- Fast-Paced Environment
- Data Entry Accuracy
- Customer Advocacy
- Cross-Functional Collaboration
- Record Management
- Trend Analysis
- Bilingual Communication
LANGUAGES
English (Fluent)
Spanish (Fluent)
Timeline
Independent Contractor
National Insurance Inspection Services
01.2020 - Current
Operations Manager
Great Depths Marine
01.2012 - 01.2020
Rental Branch Manager
Enterprise Rent-a-Car
01.2004 - 01.2011
Patient Relations Manager
Western Dental Services
01.2001 - 01.2003
B.S. - Marketing & Business Administration
University of Mobile Alabama