Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Mayte Martinez

Blue Island,IL

Summary

Motivated individual with strong work ethic and exceptional interpersonal skills, seeking new challenges. Able to work effectively unsupervised and adapt quickly to changing environments. Committed to excelling in any role with a drive for excellence. Quick learner willing to do what is necessary to successfully complete any job.

Overview

10
10
years of professional experience

Work History

Member Services System Coordinator

UNITE HERE HEALTH
06.2023 - Current
  • Enters, maintains, proofreads, and updates the Benefit Inquiry Tool (BIT) and other knowledge base tools.
  • Evaluates whether an update pertains to a specific plan or multiple plans
  • Works collaboratively with the Member Services QA, Training & Support Supervisor to determine consistent language within the BIT and prioritizes workload
  • Collaborates with Quality Assurance (QA) Specialist to identify opportunities for improvement in the tool based on QA observations
  • Collaborates with other departments to stay informed of any upcoming plan changes that will need to be updated into the BIT and shared with Member Services
  • Supports development and adheres to a quality review program for all BIT updates prior to publishing the update(s)
  • Routinely audits BIT for accuracy as well as consistency of documentation across plans
  • Maintains an audit log for all changes to the BIT
  • Provides reports on database statistics and audit findings
  • Updates Fund staff on changes to content in BIT
  • Coordinates resolving benefit interpretation discrepancies, including obtaining input from Regional Directors, Member Services management and reps, Claims, Compliance and Healthcare Delivery Support
  • Works with Communications Department to ensure hyperlinks contained within BIT are correct and functioning
  • Receives all incoming Member Services e-faxes, documents them in the Customer Relationship Management software application, and triages them
  • Notifies management of reports on statistics and findings/observations
  • Sets goals and achieves measurable results
  • Contributes ideas to plans and achieving department goals
  • Demonstrates the Fund’s Diversity and Inclusion (D&I) principles in their conduct at work and contributes to a safe inclusive culture with equitable opportunities for success and career growth
  • Exemplifies the Fund’s BETTER Values in contributing to a respectful, trusting, and engaged culture of diversity and inclusion
  • Performs other duties as assigned within the scope of responsibilities and requirements of the job
  • Performs Essential Job Functions and Duties with or without reasonable accommodation

Member Services Representative

UNITE HERE HEALTH
01.2017 - 06.2023
  • Serves as the main point of contact for the Fund's members, unions, employers, providers, and vendors on benefit, claims and eligibility issues, education and questions
  • Receives and records telephone and walk-in inquiries regarding plan benefits, claims and eligibility
  • Performs enrollment functions, including telephonic and outreach as necessary
  • Researches benefit, eligibility and claim issues and initiates corrective action with relevant departments
  • Maintains up-to-date knowledge of all systems and sources relating to plan benefits, processes, policies, etc. that will affect performance of daily tasks
  • Assists in member outreach
  • Seeks management assistance on issues unable to resolve in a timely manner
  • Exemplifies the Fund's BETTER Values in contributing to a respectful, trusting, and engaged culture of diversity and inclusion
  • Performs other duties as assigned within the scope of responsibilities and requirements of the job
  • Performs Essential Job Functions and Duties with or without reasonable accommodation
  • Answers called to support colleagues through the support, knowledge and instruction line
  • Receives caller complaints that need to be resolved

Intake Representative

MCM Solutions for Better Health
10.2015 - 01.2017
  • Received inbound calls to obtain clinical information from providers to create authorizations and referrals.
  • Verified insurance eligibility, and authorization for defined services.
  • Made outbound calls to providers to obtain information necessary to create or update authorization.
  • Updated patient information on computer system to maintain accuracy.
  • Adhered to HIPAA requirements to safeguard patient confidentiality.
  • Communicated with patients with compassion while keeping medical information private.
  • Transmitted medical records and other correspondence by e-mail or fax.

Education

Associate of Applied Science - Administration

Fox College
Bedford Park, IL
05.2015

Skills

  • Upbeat and Positive Personality
  • Efficient and Detail-Oriented
  • Bilingual
  • Proactive and takes initiative
  • Open to change

Languages

Spanish
Native or Bilingual

Timeline

Member Services System Coordinator

UNITE HERE HEALTH
06.2023 - Current

Member Services Representative

UNITE HERE HEALTH
01.2017 - 06.2023

Intake Representative

MCM Solutions for Better Health
10.2015 - 01.2017

Associate of Applied Science - Administration

Fox College

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Mayte Martinez