Yolanda Pabon
Philadelphia,PA
Summary
To seek a Care Management position that will benefit from years of experience working with a diverse population experiencing complex situations with the utmost compassion, honesty, respect and empathy. Hardworking and passionate with strong organizational skills, eager to help achieve company goals.
Overview
5
5
years of professional experience
3
3
years of post-secondary education
1
1
Language
Work History
Member Service Representative
Aetna Better Health Of Pennsylvania
Philadelphia , PA
08.2019 - Current
- Handled large volumes of inbound and outbound calls from different sources following specific call scripts facilitating communication for a positive point of contact between the company, members and providers
- Processed members and providers requests by determination of medical necessity based on verification of coverage and eligibility status in a timely manner
- Initiated incoming requests for claim inquiries, complaints, grievances and appeals
- Served as a point of contact to members and providers by redirecting callers to appropriate departments based on the nature of the call and via email
- Maintained and secured accurate documentation of all incoming calls.
- Learned and maintained in-depth understanding of benefits and information to offer knowledgeable and educated responses to diverse customer questions.
- Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.
- Followed up with customers about resolved issues to maintain high standards of customer service.
Customer Service Representative
Logisticare- Pennsylvania
Philadelphia, PA
10.2018 - 07.2019
- Manage large volumes of inbound calls, assisting clients and providers with requests for scheduling, modifying, recovering, or canceling reservations
- Processed reservation requests after verifying and determining client’s eligibility
- Worked closely with facilities and transportation providers to ensure transport for dialysis and cancer treatment
- Assured compliance by adhering to the company's policies and procedures
- Maintained proper documentation of all reservation inquiries and complaints.
Direct Support Professional
Spin Inc
Philadelphia, PA
01.2018 - 05.2018
- Offered direct support to individuals with intellectual and physical disabilities by establishing strategies for individuals with the means to accomplish daily goals, community integration, and a sense of independence.
- Transported individuals safely to outings, volunteering, and other related outdoor activities
- Completed and updated all daily notes in a timely, accurate, and professional manner.
Residential Associate
The Arc Nature Coast
Port Richey, FL
01.2017 - 04.2017
- Aided in the day-to-day direct care of support services to individuals with intellectual and/or developmental disabilities living in a home-like residential setting
- Tracked and assisted with the administration of prescribed medications
- Documented progress notes at the end of each shift in a proper and professional manner.
- Assisted residents with basic activities of daily living.
- Maintained safe working environment through prevention of accidents, preservation of equipment and achievement of safe working practices.
Peer Support Specialist
Western Massachusetts Training Consortium
Holyoke, MA
03.2016 - 11.2016
- Assisted with assessments based on information from IEP plans, family environmental and behavioral factors
- Mentored and offered support to young adults with intellectual disabilities and Autism
- Planned activities specifically designed to meet the needs of the individuals, promoting community involvement, while improving social skills
- Applied analytical/logical problem-solving techniques, thereby obtaining positive results
- Prepared and submitted bi-monthly reports of each caseload in a prompt timely manner.
- Built relationships with others based upon trust and honesty by using active listening and dynamic communication skills.
- Fostered relationships with partner agencies and other interested parties to build pipeline of supportive services.
- Communicated with individuals' family members, offering information and insight into support services available at community level.
- Displayed sensitivity to cultural and linguistic needs of clients and families served.
- Provided ongoing assessment, problem-solving and skill teaching to assist individuals with activities of daily living.
Education
Associates in Science in Law Enforcement - Criminal Justice
Springfield Technical Community College
Springfield, MA 01.2011 - 05.2014
Skills
Call center operations
undefinedVolunteer Work
Joined Citivan Volunteer Organization while in college, providing volunteer work for the homeless and other communities experiencing distress and extenuating circumstances. Participated in Holiday events created for the homeless, serving them with a dinner, and also with gifts for the children and other activities such as music, games, and gift baskets for the adults.
Timeline
Member Service Representative
Aetna Better Health Of Pennsylvania
08.2019 - Current
Customer Service Representative
Logisticare- Pennsylvania
10.2018 - 07.2019
Direct Support Professional
Spin Inc
01.2018 - 05.2018
Residential Associate
The Arc Nature Coast
01.2017 - 04.2017
Peer Support Specialist
Western Massachusetts Training Consortium
03.2016 - 11.2016
Associates in Science in Law Enforcement - Criminal Justice
Springfield Technical Community College
01.2011 - 05.2014
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