Pamela Pacheco
Hyattsville,MD
Summary
Highly trained professional with a background in verifying insurance benefits and creating appropriate member documentation. An established Health Advocate known for handling various office tasks with undeniable ease. Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to understand claim processing. Effective at operating within regulations and numerous guidelines to manage telephone calls, emails, letters and in-person requests for assistance.
Overview
16
16
years of professional experience
Work History
Elite Senior Health Advocate
United Healthcare Group
Maryland
01.2022 - Current
- Reduced claims processing time by implementing efficient workflow and prioritizing tasks.
- Enhanced customer satisfaction with timely and accurate resolution of claims disputes.
- Analyzed complex claims data, identifying trends, and recommending improvements to reduce future risks.
- Developed strong relationships with billing providers, promoting effective communication for claim resolution.
- Conducted thorough investigations of disputed claims, gathering evidence to support decision-making processes.
- Provided exceptional customer service when addressing inquiries from members regarding their claim status or policy coverage details.
- Managed a large caseload while maintaining strict deadlines and delivering consistent results under pressure situations.
- Updated field operations staff on status of open claims and current actions.
- Conducted investigations into complicated mid- and high-exposure claims.
- Followed up with customers on unresolved issues.
- Improved team productivity by assisting in escalations chat.
Subject Matter Expert Call Center Representative
CarePlus Health Plans, Inc / Humana
Maryland
10.2020 - 01.2022
- Served as member advocate to address customer needs, including acting upon complex benefit needs, resolving grievances and educating members.
- Documented member inquiries and resolutions provided per Centers for Medicare and Medicaid compliance criteria.
- Handled inbound and outbound calls and followed escalation protocol when necessary to address member needs.
- Monitored call quality and provided individual constructive feedback to enhance performance and address areas in need of improvement.
- Trained team members on performance metrics and consumer behavior identification.
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
- Minimized workflow issues and increased productivity by cross-training staff on technical procedures, protocols and customer service practices.
- Conducted performance reviews for staff members to reduce resolution times and improve customer satisfaction ratings.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows
- Developed training, task and process guidelines and communicated clear and concise directions to employees
- Achieved results by working with staff to meet established targets
- Evaluated employee performance and coached and trained to improve weak areas
- Maintained compliance with company policies, objectives and communication goals
- Mentored newly hired employees on operating equipment and safety and developed training manual to use for reference
- Set overall vision and provided team leadership
- Conducted employee evaluations to provide feedback and set expectations for future job performance
Executive Assistant
Minimally Invasive Vascular Centers
Laurel, MD
03.2017 - 10.2020
- Coordinated Vice President appointment calendar by planning and scheduling meetings, conferences, teleconferences and travel.
- Prepared meeting reports by collecting and analyzing information using Google Chrome, Word and Excel.
- Organized CEO and VP lunches and also quarterly dinners for company.
- Attended meetings and spoke on behalf of VP when absent.
- Completed confidential projects assigned by VP.
- Designated work to clerical staff, followed up on results and coordinated meetings for status.
- Oversaw office supply inventory, including checking stock levels to anticipate needs, evaluating new office products and handling supply orders and receipt.
- Conducted payroll for 30 employees
- Conducted quarterly reviews for employees
- Monitors attendance and tardiness to ensure compliance within company guidelines.
- Coordinated, supervises and is accountable for the daily/weekly/monthly activities of team members
- Enforces company policy and helps others adapt to change
- Coordinated work activities with other supervisors, managers, departments, etc
Executive Assistant
Stein Sperling Attorneys
Takoma Park, MD
06.2014 - 03.2017
- Conducted detailed client intakes and entered information into Needles software and company database.
- Investigated facts and laws to determine causes of action and prepare plaintiff cases.
- Managed personal injury and wage and hour cases from intake to disbursements.
- Created, indexed and maintained client binders.
- Organized envelopes, postage and mail correspondence for clients.
- Obtained attorney signatures for legal documents.
- Helped attorneys collect information such as employment, medical and other records.
- Arranged weekly staff meetings to meet monthly quotas.
- Assisted 1 partner and 2 associates with calendar management.
- Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork
- Led projects and analyzed data to identify opportunities for improvement
- Used critical thinking to break down problems, evaluate solutions and make decisions
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows
- Created successful work schedules for each team member to maintain deadlines and fully staff shifts
- Developed training, task and process guidelines and communicated clear and concise directions to employees
- Monitored workflow to improve employee time management and increase productivity
- Coordinated employee schedules to keep pace with business needs and meet company demands
- Handled customer complaints, resolved issues and adjusted policies to meet changing needs
Lead Unit Secretary
The George Washington University Hospital
Washington, DC
06.2012 - 03.2014
- Handled administrative responsibilities for 3 floors of intensive care department, including answering multiline phones, making copies, scheduling appointments using EMR and maintaining supplies.
- Assisted during morning rounds.
- Entered orders for registered nurses.
- Maintained clean, healthy and safe environment.
- Admitted patients, maintained records and broke down medical information from charts into hospital EMR.
- Monitored vitals such as blood pressure and pulse.
- Organized breakfast, lunch and dinner for department.
- Coordinated ICU secretary schedules for sufficient staff coverage.
- Met with charge nurses daily to obtain staff success flow.
- Coordinated employee schedules to keep pace with business needs and meet company demands
- Evaluated employee performance and coached and trained to improve weak areas
- Set overall vision and provided team leadership
- Conducted employee evaluations to provide feedback and set expectations for future job performance
- Worked with management team to implement proper division of responsibilities
Administrative Assistant
The George Washington University Medical Faculty Associates
Washington, DC
08.2008 - 06.2012
- Coordinated logistics and materials for board and committee meetings and staff events.
- Ordered and distributed office supplies while adhering to fixed office budget.
- Arranged domestic and international travel, including booking airfare, hotel and transportation for 3 physicians.
- Managed office vendors, organization and upkeep.
- Directed guests and routed deliveries and courier services.
- Answered and managed incoming and outgoing calls while recording accurate messages.
- Opened and distributed incoming mail.
- Greeted visitors, including VIPs, vendors and interview candidates.
- Assessed urgency and priorities before accepting or declining appointments with doctors.
- Obtained signatures for financial documents and internal and external invoices.
Education
Bachelor's Degree - Industrial And Organizational Psychology
Southern New Hampshire University
Manchester, NH05.2025
Associate of Science -
Everest Institute
Silver Spring, MD2008
Skills
- Call center operation
- Performance improvement
- Complaint resolution
- Customer relationship management
- Quality assurance controls
- Documentation and reporting
- Teaching
- MS Office Suite
- Adobe Creative Suite
- Google Sheets
Languages
Spanish
Native or Bilingual
Timeline
Elite Senior Health Advocate
United Healthcare Group
01.2022 - Current
Subject Matter Expert Call Center Representative
CarePlus Health Plans, Inc / Humana
10.2020 - 01.2022
Executive Assistant
Minimally Invasive Vascular Centers
03.2017 - 10.2020
Executive Assistant
Stein Sperling Attorneys
06.2014 - 03.2017
Lead Unit Secretary
The George Washington University Hospital
06.2012 - 03.2014
Administrative Assistant
The George Washington University Medical Faculty Associates
08.2008 - 06.2012
Bachelor's Degree - Industrial And Organizational Psychology
Southern New Hampshire University
Associate of Science -
Everest Institute