Maritza Scrofani
Palm Beach Gardens,FL
Summary
Highly personable Professional with over 20 years of experience in account management, claims processing, and customer service operations within the health care, insurance, and social services industries. Effective problem-solving, organizational, and time management skills in a fast-paced environment. Proficient with Microsoft Office System.
Professional with strong background in Medicaid eligibility determination and case management. Proven ability to navigate complex regulations and ensure compliance. Strong focus on team collaboration and achieving results. Known for reliability and adaptability in dynamic environments. Expertise in data analysis, client communication, and process improvement.
Overview
25
25
years of professional experience
Work History
Medicaid Eligibility Specialist
Westchester County Department of Social Services
11.2007 - 01.2025
- Assessed eligibility for Medicaid recipients based on laws, policies, and procedures, as well as agency guidelines and protocols through a thorough document review
- Worked with agencies and service providers to facilitate case coordination and information sharing
- Conducted telephone and face-to-face interviews
- Documented all actions and maintained case records
- Communicated effectively with manager and supervisor personnel and provided monthly stats
- Provided exceptional customer service by promptly addressing inquiries, resolving issues, and ensuring customer satisfaction
- Managed a heavy caseload, monitored and tracked expiration dates of coverage, and sent out recertifications
- Collaborated with cross-functional teams to escalate complex issues and provide timely resolutions
- Assisted in training new team members on company policies, procedures, and best practices for delivering excellent customer service
Customer Care Lead / Pharmacy Tech
Empire Blue Cross Blue Shield
03.2000 - 10.2007
- Provided policy coverage and benefits, maintained and recorded all customer interactions and initiated prior authorizations for required medications.
- Collected and compared data for popular brand and generic drug names, third-party prescription programs, claim settlements and managed care principles.
- Trained employees on development and implementation of policy-awareness program and enhanced employee performance and attendance through daily mentoring, one-on-one discussions and motivational strategies.
Education
Bachelor's degree - Psychology
University of Phoenix-Online Campus
08.2014
Skills
- Application processing
- Eligibility determination
- Policy interpretation
- Teamwork and collaboration
- Customer service
- Problem-solving
- Interviewing techniques
- Time management
- Attention to detail
- Effective communication skills
- Multitasking Abilities
- Reliability
- Critical thinking
- Organizational skills
- Flexibility
- Documentation and paperwork
- Decision-making
- Computer proficiency
- Task prioritization
- Self motivation
- Interpersonal skills
Languages
Spanish
Native or Bilingual
Timeline
Medicaid Eligibility Specialist
Westchester County Department of Social Services
11.2007 - 01.2025
Customer Care Lead / Pharmacy Tech
Empire Blue Cross Blue Shield
03.2000 - 10.2007
Bachelor's degree - Psychology
University of Phoenix-Online Campus
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