Veronica Calderon
Fontana,CA
Summary
Seeking a challenging and responsible position in a company that offers stability and promotes over career advancement. A Position where one can utilize their skills, one in which one can share their ideas with and learn from upper management.
Overview
21
21
years of professional experience
Work History
Member Service Representative
IEHP
Rancho Cucamonga, California
09.2023 - Current
Shift Supervisor
Coffee Bean & Tea Leaf
Pasadena, CA, CA
04.2022 - Current
- Provide on-the-job training to new staff members.
- Ensure all safety and sanitation regulations were met throughout the shift.
- Monitor staff performance to ensure quality standards were met.
- Assign tasks to team members based on their strengths and skill sets.
- Resolved customer complaints in a timely manner.
- Developed strategies for improving operational efficiency and customer service levels.
- Communicated clearly with employees regarding job duties, expectations, and policies.
- Performed cash handling duties such as counting money, balancing registers, and preparing bank deposits.
- Investigated accidents or incidents occurring during shift hours.
- Served as a role model for other employees by demonstrating professional behavior at all times.
- Provided feedback to employees regarding their performance in order to improve productivity.
- Assisted customers with product selection when needed.
- Completed opening and closing duties to facilitate business operations.
- Assisted upper management with daily operations to meet standards of service and quality.
Inpatient Coordinator
Care1st Health Plan
Monterey Park, CA
06.2012 - 09.2016
- Screened and processed all incoming face sheets (admissions).
- Generated authorizations; observations, inpatient, nicu, rehabilitation, skilled nursing and ambulance.
- Processed clinicals, Medicare prime denials, deferral letters and LCD (local coverage determinations) letters.
- Data entry.
- Answer 30-60 incoming calls on a daily basis.
- Verify eligibility and benefits.
- Managed multiple priorities and maintained effective results in a quota driven workplace.
- Out of network coordinator.
- One of top producing coordinators.
Group Service Representative
Health Net
Woodland Hills, CA.
06.2012 - 08.2012
- Assited in development of small business accounts.
- Cultivated customer loyalty, promoted repeat business and improved sales.
- Leveraged sales expertise to promote products and capitalized on upsell opportunities.
- Collected customer feedback and made process changes to exceed customer satisfaction goals.
- Liaised with customers, management and sales team to better understand customer needs and recommend appropriate solutions.
- Documented data and completed accurate updates to case records.
- Produced quality work even when under extreme pressure and deadlines.
Referral Specialist
Anthem Blue Cross
Woodland Hills, CA.
06.2011 - 06.2012
- Provided support through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs.
- Enhanced the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through integrating functions of case management and utilization review.
- Worked with Case Managers to obtain prior authorization for medical procedures.
- Built professional relationships with service providers.
- Verified insurance benefits and eligibility for medical procedures before referring clients.
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
Key Holder
Aldo
Glendale, CA.
01.2005 - 01.2006
- Managed 10-15 employees.
- Responsible for analysis of monthly, weekly, and daily sales reports.
- Processed personnel scheduling, emails, and clientele books.
- Conducted training of new part-time employees.
- Inventory.
- Extensive work with visual standards and merchandising of high-ticket items.
- Operated and responsible for sales register (s).
Sales Representative
Cingular
Burbank, CA.
01.2004 - 01.2005
- Met with existing customers and prospects to discuss business needs and recommend optimal solutions.
- Attended advanced training sessions and conferences to increase product knowledge and productivity.
- Met frequently with technical, product management and service personnel to stay current on company offerings and business policies.
- Organized sales paperwork, presented proposals and finalized contracts.
- Retained excellent client satisfaction ratings through outstanding service delivery.
- Achieved monthly sales goals by promoting product benefits and enrolling new clients.
- Assisted in product placement and visual merchandising, maintaining attractive and inviting appearance
- Technical support.
- Cashier.
Open Enrollment Specialist
- Conducted English and Spanish Open Enrollment Presentations to new and existing accounts.
- Presented insurance options to customers in order to close sales on new policies.
- Checked documentation for accuracy and validity on updated systems.
- Modified, updated and processed existing policies.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Customer Service Representative
- Answered 60-90 on a daily basis; English and Spanish inbound calls in a fast-paced, high volume call center.
- Responded to customer inquiries, requests and resolved issues efficiently and professionally.
- Exercised strong interpersonal communication skills with customers and departmental personnel.
- Managed multiple priorities and maintained effective results in a quota driven workplace.
- Utilized multiple support applications to effectively assist customers and agents.
- Accepted assignments with an open, cooperative, positive and team-orientated attitude.
- Part of Health Net Beginnings (a dedicated line assigned to new accounts).
Education
High School Diploma -
Benjamin Franklin High School
Los Angeles, CA06.2018
No Degree -
Pasadena City College
Pasadena, CASkills
- Call center operations
- Documentation and reporting
- Written and oral communication
- Multidisciplinary team collaboration
- Sales expertise
- Healthcare knowledge
- Dispute Resolution
- Customer Service
Timeline
Member Service Representative
IEHP
09.2023 - Current
Shift Supervisor
Coffee Bean & Tea Leaf
04.2022 - Current
Inpatient Coordinator
Care1st Health Plan
06.2012 - 09.2016
Group Service Representative
Health Net
06.2012 - 08.2012
Referral Specialist
Anthem Blue Cross
06.2011 - 06.2012
Key Holder
Aldo
01.2005 - 01.2006
Sales Representative
Cingular
01.2004 - 01.2005
Open Enrollment Specialist
Customer Service Representative
High School Diploma -
Benjamin Franklin High School
No Degree -
Pasadena City College