Marlene Villegas
Summary
Analyzed complex issues and communicated solutions clearly to diverse audiences, consistently meeting performance targets in dynamic environments.
Overview
5
5
years of professional experience
Work History
Grievance and Appeal Intake Coordinator
Oscar Health
Tempe, AZ, USA
03.2022
- Oversaw intake and triaging processes for member-level complaint and appeal requests.
- Analyzed processing workflows to identify inefficiencies and presented findings to leadership.
- Facilitated shadowing and training sessions to enhance skills of intake processing personnel.
- Oversaw case acknowledgment and response processes to ensure service level compliance.
- Led training initiatives to enhance management of internal grievances and appeals.
- Oversaw intake and triaging processes for member-level and state regulator complaint and appeal requests.
- Facilitated regulatory team efforts to ensure compliance with state regulations.
- Oversaw regulatory intake and ticket creation for grievance cases, ensuring compliance and efficiency.
- Aggregated provider feedback and complaints from JIRA to enhance Inovaare integration.
- Executed outbound calls to members for acquisition of AOR documents and good cause information.
- Composed dismissal letters to facilitate prompt case closures.
- Assisted in translating Spanish documents for CG&A team. Supported team by listening to Spanish calls to facilitate better communication. Provided language support to improve team operations.
- Assisted patients with Medicare intake processes to support enrollment. Provided information to patients regarding Medicare options. Collaborated with team members to enhance intake procedures.
- Assisted in processing provider zero pay appeals and vendor appeals. Supported completion of documentation for appeals and grievances. Aided team in resolving member issues effectively.
- Championed collaborative initiatives with team members and leadership to enhance operational processes.
Bilingual Care Guide
Oscar Health
Tempe, AZ, USA
03.2020 - 12.2021
- Listened to member's comments, concerns, and suggestions, relaying that information internally, while ensuring member satisfaction
- Collaborated with my team of care guides, a concierge nurses to assist our Members
- Communicated with members via inbound/outbound phone or secure messaging
- Maintained strict confidentiality and the highest level of professionalism
- Answered questions and resolved issues related to topics such as claims and billing.
- Used logic and methods to solve difficult problems with effective solutions
- Was compassionate with our Members- demonstrated empathy.
- Helped with the learning and development program (LLC) would let new hires shadow me and I would go over details of the call and tips.
- I would also shadow the new hire representatives and help them take calls and offer assistance and answer questions.
- I also assisted many times for the new hires coming into the Spanish team.
- Recruited to the Cigna plus Oscar team. Management advice would be a great fit because I had great metrics (lateral movement). Assisted Members as a care guide with a white glove treatment.
- Claim Career Experience- Did six weeks of claim processing. Assisted with awaiting confirmations. Created provider responses for claims that had been appealed. Mailed or Faxed to Providers. Used my knowledge of internal tools and technical processes to meet goals.
Bilingual Consumer Service/Collections
GM Financial
Chandler, AZ, USA
03.2018 - 01.2020
- Accountable for the day-to-day support of consumer loan accounts 5 to 45
- Ensured that payments are received in a timely manner to minimize losses
- Ensured adherence to internal policy and external regulations
- Primary focus was to maintain and reduce delinquency on accounts while minimizing losses through repossession
- Responsible for resolving all accounts to a current status
- Expected to work with little or no supervision, exercised discretion and good judgment when making decisions about accounts, and represented the company in a professional manner
- Collected in accordance with all state and federal laws inclusive of Fair Debt Collection Practices Act
- Independently evaluated each loan and determine the best course of action for the customer in resolving the problem permanently
- Independently worked with the customer on payments, deferrals(extensions) and arrangements
- Evaluated situations and delivered targeted solutions using various tools and resources.
- Negotiated to collect balance in full
- Counseled debtors on payment options and arranged installment agreements
- Used probing techniques to determine debtors' reasons for delinquency.
- Used skip tracing and other techniques to locate debtors.
Bilingual Business Consultant/ Sale & Tech
Godaddy
01.2017 - 03.2018
- Manage customer accounts through high level of consultation
- Directly responsible for selling GoDaddy products and service
- Answered questions and troubleshoot issues related to customers accounts, billing, and products
- Met daily and monthly revenue targets and other metrics related to adherence, and survey scores
- Took inbound calls from new and existing customers while working within a non-scripted call flow
- Accomplished experience selling and servicing technology products or services to small businesses and consumers
- Consulted, recommended and enabled the right online product and service strategies to help customers with their business or personal needs
- Was able to deliver stellar customer service while troubleshooting a technical support call
- Resolved diverse range of technical issues across multiple systems and applications for customers and end-users across various time zones
- Translated complex technical issues into digestible language for non-technical users.
- Activated accounts for clients interested in new services
Education
High School Equivalent -
Maricopa Community Colleges - Rio Salado Community College
Tempe, AZSkills
Adobe
Jira
Vam
Rosco
Mondaycom
Confluence
Verint
Inovaare
Microsoft Suite
Google Suite
Salesforce
CRM
Periscope
Experience
01-2026
Areas Of Expertise
Adobe, Jira, Vam, Rosco, Monday.com, Confluence, Verint, Inovaare, Microsoft Suite, Google Suite, Salesforce, CRM, Periscope, English, Spanish, World of Medicare, Part C Organization Determinations, Appeals, & Grievances
Languages
Spanish
Native or Bilingual
Timeline
Grievance and Appeal Intake Coordinator
Oscar Health
03.2022
Bilingual Care Guide
Oscar Health
03.2020 - 12.2021
Bilingual Consumer Service/Collections
GM Financial
03.2018 - 01.2020
Bilingual Business Consultant/ Sale & Tech
Godaddy
01.2017 - 03.2018
High School Equivalent -
Maricopa Community Colleges - Rio Salado Community College