Pedro Marzuca
Houston,TX
Summary
Bilingual healthcare professional with over 6 years of experience in provider services and managed care operations. Expertise in commission and contracting inquiries, issue analysis, and CMS-compliant processes. Demonstrated success in collaborating with sales teams and stakeholders to resolve complex member issues and implement process improvements aligned with organizational goals.
Overview
8
8
years of professional experience
Work History
Agent Broker Support Associate
Devoted Health
06.2023 - 06.2025
- Educated members and providers on Medicare Advantage products, policies, and updates through targeted inbound and outbound outreach.
- Provided front-line support for broker and provider inquiries, resolving concerns or escalating issues.
- Conduct proactive outreach to share product updates, policy changes, and application status, ensuring a positive and informed experience.
- Documented call summaries, demographics, and communications in CRM and internal systems, enhancing quality tracking and performance metrics.
- Maintain strict adherence to CMS regulations, quality standards, and internal policies in a high-volume contact center environment.
- Assisted in provider-related initiatives, addressing network inquiries and documentation requirements to ensure operational efficiency.
Member Services Representative II
Kelsey-Seybold Clinic
Pearland, USA
02.2020 - 05.2023
- Provided front-line customer service support to Medicare Advantage members, addressing benefits, claims, and care coordination concerns.
- Educated members on plan benefits, eligibility, and policy changes, improving understanding and satisfaction.
- Followed up on member issues, appointment scheduling, and care gaps through outbound calls, enhancing member support.
- Documented interactions, call outcomes, and member data in CRM and healthcare systems, ensuring accurate record-keeping.
- Met or exceeded contact center performance and quality metrics, maintaining high standards for documentation accuracy and compliance.
Customer Service Representative
United Healthcare
Sugar Land, USA
06.2017 - 01.2020
- Educated members on benefits, claims, and provider options, enhancing understanding and satisfaction.
- Supported Medicare Advantage members across multiple states, resolving inquiries and ensuring access to benefits.
- Documented interactions in CRM systems, ensuring adherence to quality assurance and compliance standards.
- Operated in a high-volume contact center environment, meeting productivity and quality expectations.
Education
Bachelor of Arts - Cuisine
Culinary Institute Le Notre
Houston, TXSkills
- Medicare plans
- Claims & Benefits Navigation
- Claims systems
- Network Management
- Provider Data Accuracy
- Broker support
- Outbound outreach
- Front-Line Customer Support
- Healthcare Customer Service
- Member and Provider Education
- Microsoft Office
- Call resolution
- Professional communication
- Relationship building
Awards And Acknowledgements
- Commitment Champ – Ensured team compliance with service commitments within 48 hours
- L.E.E.T. Team Member – Promoted employee engagement and team culture
- Consistent Performance – Maintained 95% compliance with call quality and documentation metrics, demonstrating reliability, attention to detail, and a strong commitment to service excellence
Timeline
Agent Broker Support Associate
Devoted Health
06.2023 - 06.2025
Member Services Representative II
Kelsey-Seybold Clinic
02.2020 - 05.2023
Customer Service Representative
United Healthcare
06.2017 - 01.2020
Bachelor of Arts - Cuisine
Culinary Institute Le Notre