Summary
Overview
Work History
Education
Skills
References
Languages
Timeline
Generic

Martha Rochez

Youngstown,OH

Summary

Dynamic Retention Specialist with proven success at Healthfirst PSHP, leveraging analytical skills and effective communication to enhance member engagement and retention. Expert in navigating Medicaid and health insurance programs, consistently resolving inquiries and promoting membership growth. Adept at implementing retention strategies that significantly improve client satisfaction and accessibility to health coverage.

Overview

13
13
years of professional experience

Work History

Retention Specialist Facilitated Enroller

Healthfirst PSHP
03.2013 - 05.2020
  • Worked with various Hospital locations and maintained a successful relationship with all providers.
  • Assisted existing members by solving any inquiries that could affect their membership with the organization.
  • Educated and provided assistance to qualified individuals through the NY State of Heath Marketplace in a Qualified Health Plan (QHP) and insurance affordability programs such as Medicaid, Child Health Plus and Essential Health Plan.
  • Certified Application Counselor for the state of New York which allows me to enroll prospects in plans that best fit our consumer needs.
  • Worked close with management by promoting membership growth within our team.
  • Signed up prospects that had no medical insurance and described the features and benefits of health insurance coverage, including cost-sharing reductions work, and outline any potential risk factor if any.
  • Responsible for assisting, sharing and reporting the recertification process; these incudes conducting new member orientation and member requests follow up.
  • Monitoring, reviewing and assisting in any area concerning members retention.
  • Assisting with the coordination and completion of required recertification telephonically.
  • Responsible in identifying and reaching clients with obstacles to access coverage, which includes supporting those who need assistance overcoming barriers to seek, find, and use their health insurance coverage.
  • Maintained a safe and healthy work environment by establishing and applying organization standards and fostering collaborative teamwork.
  • Knowledge about the health care industry, the Affordable Care Act, Medicaid, Child Health Plus, Essential Plan all levels and addressing or otherwise managing issues of access, affordability and quality health care.
  • Expert in enrolling, describing the different metal tiers within the Marketplace and how the benefits may change at different tiers based on consumers income.
  • Assist existing members with recertification when applicable.
  • Assist consumers with submission of premium payments when required.
  • Responsible for negotiating with customers / clients to renew contract and retain business.

Marketing Representative / Facilitated Enroller Retention Representative

Royal Health Care / Neighborhood Health Providers
11.2007 - 03.2013
  • Responsible for identifying, educating and enrolling individuals and families into the Manage Care Plan.
  • In addition, establishing and maintaining positive relationships within the community via outreach efforts is an on-going responsibility of the marketing representative.
  • Responsible for understanding the basic concepts of Medicaid / Medicare managed care and educating enrollees on all aspects of various NHP’s plans and answering questions about them.
  • Responsible for understanding and implementing the plan’s policies and procedures for enrollment and dis-enrollment.
  • Will also assist the member in selecting a PCP and in completing enrollment materials and other forms as required by the county.
  • Responsible for working closely with the Call Center (Marketing Department) and the Member Services Department to resolve member concerns and complaints that affect potential enrollments or cause dis-enrollments.
  • Understanding and selling the services provided by the Plan, such as covered benefits, non-covered benefits and exclusions.
  • This may be done on a one- to –one or group basis.
  • Responsible for describing features and benefits of health insurance coverage, including cost sharing mechanisms like deductibles, co-pays, coinsurance and how these work/ and or affect the consumer.

Education

Administrative Assistant -

Renton Technical College
Renton
01.1999

Travel & Tourism -

Travel Careers International
New York, NY
01.1996

A.A.S Travel & Tourism -

Kingsborough Community College (CUNY)
01.1994

High School Diploma -

Park West High School
New York, NY
01.1991

Skills

  • Microsoft Office Suite
  • Analytical skills
  • Attention to detail
  • Organizational skills
  • Time management
  • Problem solving
  • Confidentiality practices
  • Retention strategies
  • Effective communication
  • Conflict resolution

References

Furnished upon request

Languages

Fluent literate native Spanish language abilities

Timeline

Retention Specialist Facilitated Enroller

Healthfirst PSHP
03.2013 - 05.2020

Marketing Representative / Facilitated Enroller Retention Representative

Royal Health Care / Neighborhood Health Providers
11.2007 - 03.2013

Administrative Assistant -

Renton Technical College

Travel & Tourism -

Travel Careers International

A.A.S Travel & Tourism -

Kingsborough Community College (CUNY)

High School Diploma -

Park West High School

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