Martha De Leon

• Coordinate health services data management activities and reporting processes to support operational and compliance objectives.

• Perform quality reviews and audits to ensure adherence to company standards, regulatory requirements, and healthcare guidelines.

• Analyze quality monitoring results to identify trends, risks, and opportunities for process improvement.

• Participate in calibration sessions to ensure consistency and accuracy in quality evaluations.

• Collaborate with leadership and operational teams to improve workflows, increase efficiency, and enhance service quality.

• Monitor quality metrics and provide actionable feedback to support continuous improvement initiatives.

• Ensure compliance with organizational policies, procedures, and regulatory requirements.

• Assisted members and providers with benefit, eligibility, claims, referral, and authorization inquiries.

• Researched and resolved complex issues while maintaining established service-level expectations.

• Investigated claims, billing, and authorization discrepancies and coordinated issue resolution with internal departments.

• Consistently met and exceeded quality and performance metrics.

• Supported special projects, floor support initiatives, member outreach campaigns, and employee engagement activities.

• Supported Medicare Advantage enrollment and verification processes.

• Assisted members with eligibility, benefits, referrals, and authorization inquiries.

• Utilized ePACES and MARx systems to verify Medicaid and Medicare information.

• Managed escalated member concerns and ensured timely resolution.

• Maintained compliance with healthcare regulations and enrollment requirements.

• Conducted quality inspections to ensure products met customer specifications and regulatory standards.

• Performed quality control activities in accordance with FDA, GMP, and ISO requirements.

• Maintained accurate inspection records and production documentation.

• Supported manufacturing operations while ensuring product quality and patient safety.

• Promoted compliance with health, safety, and environmental regulations.