Melissa Hevia
Miami,FL
Summary
Well-qualified Training Specialist adept at planning and implementing onsite and remote training programs. Authoritative and clear communicator with enthusiastic style and insightful approach. Hardworking Training Coordinator well-versed in handling all support functions and managing communication between trainers and participants. Skilled in identifying areas of focus. Enthusiastic about contributing to successful training programs. Knowledgeable about coordinating schedules and program implementation.
Overview
6
6
years of professional experience
Work History
Training Associate
Optum
09.2022 - Current
- Positions in this function are responsible for training within the HouseCalls program.
- Facilitate engaging training experiences in a virtual setting.
- Conduct training for newly hired operational team members on core systems, processes, and applications.
- Provide training on culture and values aligned with Our United Culture
- Deliver training using multiple mediums – classroom, webinar, blended learning approaches.
- Deliver continuing education, up skill, and performance improvement training as necessary.
- Provide feedback to trainees and Leaders regarding trainee performance, class progress, areas of strength and areas of improvement.
- Establish effective working relationships with all levels of staff and management.
- Provide training expertise to various departments and peers.
- Perform other duties to support projects contributing to department goals.
- Partnering with Design to implement training material.
Navigate4Me Service Navigator (Clinical Dept)
UnitedHealthcare
03.2019 - 09.2022
- Responsible for coordination of member navigation plans with Optum clinical and non - clinical staff supporting members in the Navigate4Me program including members referred for CHF, DHN, PSU, HPC, Advanced Illness, ESRD and Transplant.
- This role work one - on - one with assigned Optum clinical and non - clinical staff and will support members and their caregivers associated with that assignment in a case management capacity.
- Conduct proactive research on assigned member accounts to identify service issues and inform member plan of navigation in coordination with assigned Optum clinical and / or non - clinical staff outreach.
- Research includes, but is not limited to: Recent contacts, Alerts, PCP on account, LIS, Medicaid, Appeals, Billing, Claims Denials, Pas, Mail Order, and Transportation.
- Communicate with assigned Optum clinical and / or non - clinical staff regarding member service issues that are proactively identified, member identified and close the loop on the resolution of service issues to inform the plan of navigation for assigned members
- Resolve member service inquiries related to: medical benefits, eligibility and claims.
- Terminology and plan design, financial spending accounts, Pharmacy benefits, eligibility and claims, Correspondence requests, Educate members about the fundamentals of health care benefits including: Managing health and well-being, Maximizing the value of their health plan benefits, Selecting the best health plan to meet their health needs, Choosing a quality care provider and appointment scheduling, Premium provider education and steerage, Pre - authorization and pre - determination requests and status.
- Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow - up with the member.
- Communicate with members and their care givers regarding anticipated member service needs and resolution of issues.
- Research complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs or potential opportunities to improve the experience.
- Interact with executives and senior leaders to identify and / or resolve member issues including ongoing communication of issue outcome.
- Build and maintain an elaborate list of business partners across all lines of business to escalate member inquiries on an as needed basis. Work independently after hours to resolve urgent issues that surface after normal business hours. The ability to work outside of established procedures to ensure high level member satisfaction.
- Identify gaps in processes and work closely with other departments for process improvement.
- Provide education and status on previously submitted pre - authorizations or pre - determination requests.
- Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance.
- Maximize use of community services, support programs, and resources available to member
Bilingual Customer Service Care Coordinator
United Healthcare
10.2017 - 03.2019
- Responsible for providing compassionate customer service and issue resolution to our members. Direct phone - based customer interaction to answer and resolve a wide variety of inquiries. Responsible for coordination of member navigation plans with health plan clinical and non-clinical staff supporting members enrolled in DSNP benefits including members, or families with members, identified as having complex illness.
- Took ownership of customers issues to follow problems through to resolution.
- Direct phone - based customer interaction to answer and resolve a wide variety of inquiries.
- Responsible for coordination of member navigation plans with health plan clinical and non-clinical staff supporting members enrolled in DSNP benefits including members, or families with members, identified as having complex illness.
- Provide concierge and white-glove level service, removing burdens and providing end-to-end resolution for customers.
- Serve as a single point of contact for the customer and form a strong relationship to support them.
- Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.
- Research complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs or potential opportunities to improve the experience.
- Respond to and own consumer inquiries and issues. Conduct proactive research on assigned member accounts to identify service issues.
- Identify gaps in processes and work closely with other departments for process improvement.
- Provide education and status on previously submitted pre-authorizations or pre-determination requests.
- Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance Bilingual (Spanish / English) Customer Service Care Coordinator.
Education
High School Diploma -
Felix Varela Senior High
Miami, FL06.2004
Skills
- Role Playing
- Business Administration
- Learning Management System Proficiency
- New Employee Orientation
- Training Materials and Documentation
- Employee Performance Management System
- Orientation Sessions
- Material Preparation
- Electronic Document Management System
- Team Management
- Learning Techniques
- Motivational Speaking
- Training Solutions Development
- Product Development
- Feedback Gathering
- Presentation Materials
- Standard Operating Procedures Maintenance
- Training and Development Skills
- Materials Organization
- Schedule Coordination
- Staffing and Workflow Planning
- Project Management
- Leadership Training
- Performance Measurement
- Program Support
- New Hire Onboarding
- Program Implementation
- Confidential Records Management
- Corporate Training Programs
- Employee Timesheet Processing
Languages
Spanish
Native or Bilingual
Timeline
Training Associate
Optum
09.2022 - Current
Navigate4Me Service Navigator (Clinical Dept)
UnitedHealthcare
03.2019 - 09.2022
Bilingual Customer Service Care Coordinator
United Healthcare
10.2017 - 03.2019
High School Diploma -
Felix Varela Senior High
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