Mauricio Navarro
Orlando
Summary
Experienced and results-oriented call center leader with a strong background in health insurance operations, team development, and customer experience management. Seeking a Senior Manager or Director role where I can leverage over 9 years of leadership in high-volume call center environments to drive performance, streamline processes, and enhance member satisfaction. Proven ability to lead cross-functional teams, implement scalable service strategies, and ensure compliance within regulated healthcare settings.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Manager
HealthFirst
06.2019 - Current
- Leads and directs teams and functions related to servicing our members and/or providers by inbound/outbound calls/emails/chats, onsite/remote/virtual on behalf of CCO
- Ensures KPIs including quality, productivity, and dependability requirements are met or exceeded through direct/indirect leadership
- Ensures the execution of established policies and procedures to ensure department priorities and/or deliverables are achieved
- Provides status reports to management on all assigned activities, Service Level Agreements (SLA), active campaigns, department and employee concerns, customer service and sales related issues
- Coaches and provides career development to team on a regular basis
- Actively participates in employee selection, promotions, staffing assignments, retention and engagement efforts
- Establishes and communicates daily/weekly/monthly/annual priorities, expectations, and general departmental/corporate communication(s) to improve overall customer experience levels/KPIs /general Healthfirst knowledge
- Builds sustainable relationships of trust through open and interactive communication with internal and external customers
Team Leader
HealthFirst
08.2017 - 05.2019
- Lead and direct a team of 20-25 agents including senior service agents
- Conduct monthly meetings with agents to monitor their performance and meet or exceed departmental goals
- Maintained QA standards for staff, ensured CMS/audit calls are handled correctly and in a timely manner, escalate issues as needed, and maintain communication with external and internal customers.
- Provide performance coaching and implement strategies for career development for agents and senior agents.
- Identifies potential quality and performance issues, and take proactive measures for corrective performance improvements
Senior Lead Representative
HealthFirst
10.2016 - 08.2017
- Provides high quality assistance to the team via phone, chat, video call, email, in person and/or other communication channels related to servicing our members and/or providers.
- Responsible for meeting assigned departmental productivity, quality, dependability standards, and assist and resolve complex member/provider inquiries and escalations
- Identified potential quality and performance issues and takes a proactive approach to recommend solutions and methods for process improvement
- Assist Team Leads with general departmental/corporate communications to team members
- Assist with new hire training/cross training/refresher training as needed
- Provide status reports to Team Lead on assigned activities
Member Services Representative
HealthFirst
10.2014 - 10.2016
- Provide excellent quality customer service to all Lines of Businesses for members and providers with a variety of questions and issues on topics such as eligibility, benefits, claims process, escalations and product
- Communicate with members and providers through various channels through inbound and outbound calls, emails or chats
- Meet or exceed all performance KPIs including but not limited to quality, productivity and dependability
- Identify and de-escalate situations where member/provider is upset and provide a satisfactory resolution
- Assist with CCO inbound contacts on high volume days, while not missing any deliverables associated with individual and team accountabilities
Credit Consultant
Vilacom Credit Repair
05.2012 - 04.2014
- Consulted and educated clients on their credit report analysis that is generated from all 3 credit bureaus
- Enter new client’s information into privacy matters date base and collected payments to start process
- Explain the process of how we removed delinquent accounts, and the estimated time frame
- Supervised and prioritized important issues that need immediate attention
- Sending verification letters to collection agencies as well as requesting credit bureaus to remove delinquent accounts that were unable to be verified by collection agencies
Front Desk Assistant
Central Florida Pain Management
01.2009 - 02.2010
- Welcome or direct visitors, guests and patients as they arrive at the facility
- Assisted in scheduling appointments in time slots
- Assisted patients with any inquiries in person or over the phone
- Verify eligibility through system or phone if required
Education
Bachelor of Science - Health Services Administration
University of Central Florida
Orlando, FL12.2014
Associates of Arts - General Education
Valencia Community College
Orlando, FL05.2012
Skills
- Data-driven decision making
- Performance analysis
- Strategic Planning
- Execution
- Cross-Functional Team Leadership
- Coordination
- Process Improvement
- Workflow optimization
- Stakeholder Communication
- Collaboration
Accomplishments
- Received accolades in a company-wide letter addressed to the CEO of Healthfirst for exemplary leadership in resolving an urgent and complex member issue, showcasing a strong commitment to member satisfaction and operational excellence.
- Led the development of an interactive Senior Guidebook, providing valuable resources and tools for management, which enhanced team efficiency and streamlined internal communication.
- Played a key role in onboarding a new vendor, ensuring seamless integration by designing and delivering comprehensive training programs, resulting in improved vendor alignment and operational performance.
Languages
Spanish
Full Professional
Certification
Six Sigma Green Belt Certification
Timeline
Manager
HealthFirst
06.2019 - Current
Team Leader
HealthFirst
08.2017 - 05.2019
Senior Lead Representative
HealthFirst
10.2016 - 08.2017
Member Services Representative
HealthFirst
10.2014 - 10.2016
Credit Consultant
Vilacom Credit Repair
05.2012 - 04.2014
Front Desk Assistant
Central Florida Pain Management
01.2009 - 02.2010
Associates of Arts - General Education
Valencia Community College
Bachelor of Science - Health Services Administration
University of Central Florida
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