Odette Jerez
Hialeah,Florida
Summary
Dynamic leader with extensive experience at Molina Healthcare, excelling in employee engagement and quality control. Proven track record in developing training programs and enhancing team performance, consistently achieving KPIs. Bilingual communicator skilled in coaching and mentoring, fostering a culture of excellence and operational efficiency.
Overview
27
27
years of professional experience
Work History
Supervisor, Member Services
Molina Healthcare
Doral, FL
01.2015 - Current
- Lead and coach a high-performing team of 20+ employees, including team leads, to deliver exceptional service to members and providers.
- Conducted monthly one-on-one coaching sessions to enhance adherence, quality, HEDIS, and call efficiency metrics.
- Assess training needs, develop training programs, and oversee cross-training initiatives to enhance staff skillsets and operational flexibility.
- Compile and submit monthly KPI and performance reports for senior leadership review.
- Consistently recognized for improving team quality scores and maintaining strong member satisfaction outcomes.
- Mentored team members and leads, providing guidance and development support to facilitate career growth and advancement within the organization.
- Supervised a team of 20+ employees during the rollout of the Duals Team 2026 initiative.
Manager / Supervisor, Grievance & Appeals
Florida Healthcare Plus, Inc.
Coral Gables, FL
01.2013 - 01.2014
- Oversaw daily operations for Grievance and Appeals Department across HMO, PPO, and Medicare/Medicaid lines, ensuring compliance with state and federal regulations.
- Investigated, analyzed, and resolved complaints and appeals, achieving timely resolutions that enhanced customer satisfaction.
- Prepared and submitted MAXIMUS and DFS response packages within regulatory timelines, facilitating adherence to compliance requirements.
- Developed departmental policies, SOPs, and training materials to improve consistency and operational efficiency.
- Successfully led internal audits (HEDIS, Data Validation, CMS) with positive results.
- Presented monthly reports to Medical Directors and Appeals Committees.
Member Services Manager / Supervisor
Florida Healthcare Plus, Inc.
Coral Gables, FL
01.2012 - 01.2013
- Managed operations of Member Services Call Center, overseeing scheduling, policy enforcement, staff training, and performance management to ensure service quality.
- Trained and mentored staff on plan policies, procedures, and product knowledge, serving as the primary resource for complex inquiries.
- Enhanced team efficiency by streamlining call-handling processes and fostering cross-functional collaboration.
- Produced operational reports for executive leadership, providing insights on call center performance and trends.
Manager / Supervisor, Grievance & Appeals
Coventry Health Plan (formerly Vista Health Plan)
Sunrise, FL
01.2007 - 01.2012
- Oversaw daily operations for the Grievance and Appeals Department across HMO, PPO, and Medicare/Medicaid lines of business while ensuring full compliance with state and federal regulations.
- Investigated, analyzed, and resolved complaints and appeals, achieving timely resolutions and enhancing member satisfaction.
- Presented monthly reports to Medical Directors and Appeals Committees, providing insights to inform decision-making.
- Prepared and submitted MAXIMUS and DFS response packages, ensuring compliance with regulatory timelines and requirements.
- Developed departmental policies, SOPs, and training materials to improve consistency and operational efficiency.
- Successfully led internal audits (HEDIS, Data Validation, CMS) with positive results.
Customer Service Team Leader
Florida Healthcare Plus, Inc.
Coral Gables, FL
01.2003 - 01.2007
- Supervised customer service operations, ensuring compliance with HIPAA and company policies to maintain service standards.
- Authored training manuals and facilitated staff training and cross-training to enhance team capabilities.
- Implemented workflow improvements that streamlined processes and enhanced service quality.
Customer Service Representative
Florida Healthcare Plus, Inc.
Coral Gables, FL
01.1999 - 01.2003
- Delivered front-line support to members, resolving billing inquiries, service requests, and complaints, ensuring a positive customer experience.
- Surpassed customer satisfaction metrics, earning recognition for outstanding service delivery.
- Assisted clients with healthcare inquiries and resolved issues efficiently.
- Managed patient records using electronic health record systems.
- Coordinated communication between patients and healthcare providers effectively.
Education
City College -
City College
01-2003
Skills
- Program development
- Project management
- KPI reporting
- Quality control
- Employee engagement
- Staff education
- Employee development
- Bilingual Speaker
- Attention to detail
- Problem solving
- Coaching
- Effective communication
References
Available upon request
Timeline
Supervisor, Member Services
Molina Healthcare
01.2015 - Current
Manager / Supervisor, Grievance & Appeals
Florida Healthcare Plus, Inc.
01.2013 - 01.2014
Member Services Manager / Supervisor
Florida Healthcare Plus, Inc.
01.2012 - 01.2013
Manager / Supervisor, Grievance & Appeals
Coventry Health Plan (formerly Vista Health Plan)
01.2007 - 01.2012
Customer Service Team Leader
Florida Healthcare Plus, Inc.
01.2003 - 01.2007
Customer Service Representative
Florida Healthcare Plus, Inc.
01.1999 - 01.2003
City College -
City College