Michelle Medrano Gutshall
Schertz,TX
Summary
Experienced with client relationship management, enhancing customer satisfaction through personalized service and strategic account planning. Utilizes negotiation and conflict resolution skills to maintain and renew client contracts, ensuring alignment with business objectives. Track record of leveraging analytical insights to drive client retention and business development.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Texas Medicare Account Manager
WellCare Comprehensive Health Plans, Inc.
09.2021 - 05.2025
- Communicates and interprets administrative and operating policies and procedures for brokers, members, and Management.
- Worked closely with the sales team to prioritize tasks, set goals, and allocate resources efficiently; resulting in increased productivity and revenue.
- Prepare and coordinate records, statistics, organize weekly/monthly sales reports regarding operations for our Sales and Management staff in a timely manner.
- Gathers information for meetings, programs, events or conferences by arranging facilities and caterers, issuing information or invitations, coordinating speakers, preparing materials and assisting with controlling event budget.
- Prepares monthly sales prospects and leads for distribution to Field Marketing Offices (FMO) and brokers.
- Attend and assist events for brokers and Medicare members.
- Assist as a backup for Regional Area Managers on presentations to our brokers, agencies, doctor offices and vendors providing the current health plan benefits, policies, training.
- Work with internal departments to ensure seamless support with enrollment, salesforce, support tickets, customer service, broker services, marketing, and other departments.
- Served as a liaison between internal departments such as production, training, marketing, broker services, and other departments to ensure seamless end-to-end management of client accounts.
Lead Customer Service Rep.
Centene
10.2019 - 09.2021
- Managed a team of customer service representatives, consistently achieving performance targets and goals.
- Conducted regular team meetings to share best practices, discuss challenges, and foster a collaborative work environment.
- Ensured all customer complaints were addressed promptly, resulting in a significant reduction in escalations.
- Trained, oversaw, and mentored new team members to strengthen performance and job expertise.
- Identify member benefit errors and escalate to the appropriate department.
- Continuously sought opportunities for professional development and stayed current with industry trends to enhance job performance.
- Creating training presentations to provide agents with continuous updates to policies and procedures
- Coach agents on adherence, quality, system issues, and metrics to constantly improve the team performance
- Created a rebuttal repository for leads to increase the process efficiency for all of the teams
- Took lead role in the deployment of the Macess process including training and assisting leads and supervisors
- Assist supervisor with tracking and maintaining various projects and personnel statistics.
- Provide support and training to Team Leads on new processes and procedures.
Grievance Coordinator I
Centene
06.2018 - 10.2019
- Completed comprehensive review of all grievances to verify adherence of company guidelines and legal guidelines.
- Create, research and complete complex Grievances in Prime system.
- Assist in special projects, provide education and training to company staff, tracking first call resolutions, organizing data, researching information.
- Review Grievance documents to validate oral and formal Grievances
- Spearheaded initiatives for continuous improvement in the grievance management process, resulting in increased efficiency across the department.
- Maintain files on individual appeals and grievances with data entry, tracking, organizing, and researching information.
Member Advocate
Centene
05.2017 - 06.2018
- Provided specialized assistance to members with escalated issues.
- Maintained up-to-date knowledge of industry trends and best practices, adapting processes as needed to deliver exceptional support services for all members.
- Managed escalated cases effectively, working closely with supervisors to ensure successful outcomes for all parties involved.
- Consistently met or exceeded performance metrics related to response times, issue resolution rates, and overall customer satisfaction scores.
- Improved response times by optimizing workflow processes.
- Primary contact for the member and the liaison between the plan and providers to provide seamless resolution.
- Effectively respond to internal and external partners to resolve member issues in a timely manner.
Customer Service Rep. II
Centene
05.2016 - 05.2017
- Answered inquiries, walked the floor, and served as the acting lead for weekend coverage during the Annual Enrollment Period to support leads and teams.
- Remained up-to-date and adhere to quality standards, regulations, and all other policies to ensure quality, consistency, and compliance.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Volunteer for complicated challenges and assisted with special projects.
- Responded to customer requests for products, services, and company information.
Education
GED -
San Antonio College
San Antonio, TX04-1996
Skills
- Account management
- Customer service
- Teamwork and collaboration
- Client relations
- Customer satisfaction
- Relationship building
- Customer relationships
- Team Training
- Goals and performance
- Customer relationship management (CRM)
- Cross-functional collaboration
- Vendor relations
Certification
- General lines Life, Accident, Health & HMO License - 11/23/2021 -10/31/2025
Timeline
Texas Medicare Account Manager
WellCare Comprehensive Health Plans, Inc.
09.2021 - 05.2025
Lead Customer Service Rep.
Centene
10.2019 - 09.2021
Grievance Coordinator I
Centene
06.2018 - 10.2019
Member Advocate
Centene
05.2017 - 06.2018
Customer Service Rep. II
Centene
05.2016 - 05.2017
GED -
San Antonio College
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