Rodolfo Moreno
San Antonio,TX
Summary
Quality assurance professional with strong background in leading teams and ensuring high standards. Skilled in process optimization, problem-solving, and maintaining compliance with industry regulations. Known for fostering collaboration, adapting to changing needs, and consistently delivering results. Demonstrating a strong ability to thrive under pressure and adapt to evolving challenges Reliable and focused on continuous improvement and team success.
Overview
22
22
years of professional experience
Work History
Quality Team Lead
Optum / Wellmed - United Health Group
San Antonio, TX
01.2022 - Current
- Facilitated refresher training and onboarding for new audit team members.
- Reviewed and addressed rebuttals across quality departments to ensure prompt resolution.
- Conducted spot checks on a minimum of seven audits for each auditor every month. Provided training and guidance when trends were identified to improve auditor performance. Delivered constructive feedback and coaching to help auditors recognize and correct mistakes.
- Oversaw staff operations during supervisor's absence and communicated essential reports to team members as required. Finalized and delivered comprehensive monthly reports to management. Guided staff in resolving audit-related questions and system login challenges.
- Facilitated daily audit assignments for audit teams during staff absences due to leave or PTO.
Quality Analyst, Wellmed Medical Management
United Healthcare
San Antonio, TX
04.2016 - 01.2022
- Analyzed and assessed claim call interactions to identify areas for improvement in customer service delivery.
- Analyzed call recordings to ensure accuracy and alignment with operational protocols outlined in SOPs and job aids.
- Analyzed discrepancies and communicated corrective feedback, detailing essential references for improved error resolution.
- Conducted thorough reviews of claims data entry to verify consistency with provider office submissions.
Enrollment Quality Analyst
XL Health Group
San Antonio, TX
06.2013 - 04.2016
- Conducted thorough audits to enhance operational efficiency and maintain consistent quality standards.
- Conducted thorough research to ensure precise processing of Medicare benefits plan enrollment modifications.
- Identified errors in audits and provided constructive feedback to team members for continuous improvement.
- Assisted in organizing relevant documents into image repository to support productivity goals and quality expectations. Facilitated document placement in image repository to meet schedule and standards.
Enrollment Service Specialist
XL Health Group
San Antonio, TX
11.2012 - 06.2013
- Conducted thorough research and analysis to identify and rectify discrepancies in Medicare eligibility and benefits, maintaining compliance year-round and during AEP enrollments.
- Directed issue escalation to relevant departments to ensure timely resolution.
- Maintained up-to-date knowledge of Medicare guidelines and Chapter 2 to ensure compliance and support operations.
Customer Service Specialist
Wellmed
San Antonio, TX
03.2011 - 11.2012
- Facilitated member and provider inquiries regarding Medicare benefits and eligibility requirements.
- Investigated claims issues and coordinated with appropriate departments to ensure timely adjustments and thorough documentation of each call.
Customer Service Specialist
Leading Edge Personnel
San Antonio, TX
09.2010 - 03.2011
- Temp to Hire at Wellmed- responsible for answering inbound calls in a manner that will ensure high member, and clinic satisfaction, assist with claims issues, verifying member eligibility and benefits.
Customer service Consultant
Community First Health Plans
San Antonio, TX
08.2009 - 09.2010
- Streamlined verification of Medicaid member benefits and eligibility to enhance service quality. Captured and recorded all incoming calls from members and providers for quality assurance.
Customer Service Returns
Marshalls Store
San Antonio, TX
12.2008 - 02.2009
- Ensured customer satisfaction through efficient and professional management of product returns and exchanges.
Customer Service Representative
United Healthcare
San Antonio, TX
07.2004 - 03.2007
- Managed provider inbound call handling to enhance service efficiency and meet established quality benchmarks.
- Assisted members with dental benefits inquiries and provided insurance verification to providers. Facilitated claims resolution by supporting members with claims-related issues.
Education
High School Diploma - undefined
Lake View High School
San Angelo, TX05-2001
Skills
- Computer proficiency
- Communication and Organizational skills both individually and with teams settings
- Demonstrated written, verbal, business communication skills
- Problem Solving, identifying issues, analyzing root causes, and implementing effective solutions to improve process and outcomes
- Team leader decision makings Skills
- Customer Service Skills
- Skilled at thriving in a goal oriented production environment
- Proficient in Excel, Word, Microsoft Outlook
Timeline
Quality Team Lead
Optum / Wellmed - United Health Group
01.2022 - Current
Quality Analyst, Wellmed Medical Management
United Healthcare
04.2016 - 01.2022
Enrollment Quality Analyst
XL Health Group
06.2013 - 04.2016
Enrollment Service Specialist
XL Health Group
11.2012 - 06.2013
Customer Service Specialist
Wellmed
03.2011 - 11.2012
Customer Service Specialist
Leading Edge Personnel
09.2010 - 03.2011
Customer service Consultant
Community First Health Plans
08.2009 - 09.2010
Customer Service Returns
Marshalls Store
12.2008 - 02.2009
Customer Service Representative
United Healthcare
07.2004 - 03.2007
High School Diploma - undefined
Lake View High School