Marleen Ramirez
Kissimmee,FL
Summary
Goal and detail-oriented Healthcare Professional who believes that good customer service can be reached by analyzing performance numbers. Delivering accurate reports to help effective training and understanding the value of Quality and leadership, while maintaining and creating a proven customer satisfaction record.
Overview
7
7
years of professional experience
Work History
Quality Assurance Specialist II
Centene Corporation
03.2023 - Current
- Ensure compliance with company quality standards on all contact channels while monitoring key performance metrics to improve call quality
- Audit inbound and outbound calls
- Collaborate in calibration sessions to maintain consistency in internal evaluations
- Accompany evaluations with meaningful and constructive feedback
- Develop reports that outlines necessary steps to address and correct trends in audit findings
- Audit escalated calls from PORT department
- Developed audit process training guide for PORT Department
- Nominated as Employee Of The month for October 2023
Lead Customer Service Representative
Centene Corporation
09.2021 - 03.2023
- Create strategies to improve KPIs (Key Performance Indicator)
- Assign tasks, provide project updates, and coordinate meetings
- Review QA’s results and conduct appropriate auditing processes and coaching
- Collaborate with other departments on cross functional tasks to maintain performance and quality standards
- Mentored Nesting classes following CSR Proficiency Skill checklist and agenda
- Oversee daily operations of the team by evaluating performance to ensure customer satisfaction
- Collaborated with Trainers as Subject Matter Expert by providing knowledge and expertise
Customer Service Advocate
Centene Corporation
04.2018 - 09.2021
- Provide members with detailed benefits, eligibility and claims information and appeals processes
- Review medical and pharmaceutical authorizations for members
- Contributed with organizing and hosting employee focus group
Behavioral Health Services • Centene Corporation
02.2018 - 04.2018
- Attend to members and providers with excellent customer on behavioral health services
- Appoint in-patient and out-patient Authorizations for Baker acted Behavioral Health members
- Present members with behavioral health providers lists based on their needs
Quality Assurance Representative
02.2017 - 01.2018
- Secure Transportation
- Record and Initiate investigations, of sexual harassment complaints and car collision reports
- Monitor complaints and identify quality risks
- Initiates corrective actions through QA system
- Perform quality audits of processes to ensure adherence to policies and procedures
- Work closely with District Managers and Operation Supervisors with Molina Health Care
Education
HIPO Graduate -
Centene Corporation
2023
Skills
- Analytical decision making
- Strategic Planning
- Bilingual English & Spanish
- Scheduling and Time Management
- Staff training and Mentoring
- Omni and CareConnects systems
- CRM/Avaya systems
- Medicaid, Medicare, and ACA
Timeline
Quality Assurance Specialist II
Centene Corporation
03.2023 - Current
Lead Customer Service Representative
Centene Corporation
09.2021 - 03.2023
Customer Service Advocate
Centene Corporation
04.2018 - 09.2021
Behavioral Health Services • Centene Corporation
02.2018 - 04.2018
Quality Assurance Representative
02.2017 - 01.2018
HIPO Graduate -
Centene Corporation