Veronica Zelaya

Team Leadership and Performance Management: Led a team of 12 concierge advocates, achieving a 15% increase in quality assurance scores, year over year. Responsibilities included performance management, coaching, and professional development to achieve departmental goals.

Communication Strategy Development and Implementation: Developed and implemented a comprehensive communication strategy for the department, including creating a dedicated team of five advocates and establishing a centralized departmental communication inbox. This initiative streamlined internal communications and facilitated efficient knowledge sharing across the department, centralizing 90% of process update email communication into one inbox. Provided training to the team in effective email communication techniques.

Knowledge Management and Collaboration: Established and led a team of six, managing a departmental SharePoint site to enhance communication and provide a centralized repository for process updates, holiday event planning, and employee engagement initiatives. This initiative fostered professional development, including training in communication, Excel, PowerPoint, and Microsoft Teams (surveys and polls), resulting in improved employee morale, and increased team participation in departmental activities.

Process Improvement and Training: Played a key role on numerous departmental committees, contributing to the development and implementation of new processes. Contributed to committees that developed three new processes, resulting in a 90% improvement in operational efficiency,

Medicare Member Services Expertise: I have extensive knowledge of internal and external processes related to Medicare CMS guidelines for member services, including enrollment, claims processing, appeals, and grievance procedures. My five years of experience working directly with Medicare members has given me a deep understanding of their perspective, particularly regarding the importance of timely grievance and appeals processing. I have consistently collaborated with the grievance and appeals team, fostering an environment of compliance with their guidelines and procedures, to ensure positive member experiences.

• Leading team to provide concierge services to assigned PMG members
• Building relationship with medical group personnel
• Extracting data from Tableau software system into excel form
• Communicated findings that have led to new implementation in the department
• Analyzing data and communicating findings and delegating to team or management to resolve if needed
• Monthly meetings with medical group to provide findings and work together to improve provider relations and member experience
• Managing pharmacy inbox and communicating with inter departments to resolve pharmacy issues
• Voice of the customer surveys analyzing and service recovery
• Also providing coaching to associates if needed
• Leading team to exceed in Net Promoter Score for the department

• Participated in piloting the concierge business method for member services
• Communicated findings that can better improve best practices
• Assisted in leading a section of the pharmacy training
• Piloted work from home Awesome program for Concierge to offer recommendations on existing functionalities to improve the program
• Maintained high quality scores with providing one call resolution, critical thinking, and Concierge services to members

• Inbound calls providing beneficiaries benefits, plan options, and copay information
• Customer advocacy: Strong customer service
• Knowledge in Medicare procedures and benefits
• Member billing: taking payments through banking system US bank
• Member balance billing-
• Pharmacy specialist’s; expert matter on the Medicare benefit pharmacy structure
• Providing members with benefit and community resources for extra help for housing, low income, and caregiving resources

• Inbound call center for provider electronic payments and statements financial department
• Provided providers with payment information payment date and eft number
• Sent EOBS and EPRAS to verify users through secure delivery
• Provided information on overpayment adjustments
• Informed callers on their health and wellness benefit
• Helped caller navigate through the Health and Wellness website

• Inbound calls; sales department for Blue Cross Blue Shield
• Provided Knowledge on Affordable Care Act
• Great verbal and written communication skills
• Ensured customer retention and loyalty
• Verified and gathered data on potential prospects
• Able to manage high volume of calls during open enrollment deadline

• Interpret medical records, assigned appropriate ICD-9 codes
• Entered demographics information
• Verified insurance, update patient demographics accordingly
• Mailing CMS 1500 forms to insurance companies for collection of payment