Selena Sepulveda
Phoenix,Phoenix
Summary
Bilingual Professional Change Management Specialist with deep expertise in guiding organizational transformations. Skilled in process improvement, stakeholder communication, and risk management. Strong focus on team collaboration and driving results, with adaptability to evolving needs. Known for analytical thinking, problem-solving, and effective leadership. Thorough team contributor with strong organizational capabilities. Experienced in handling numerous projects at once while ensuring accuracy. Effective at prioritizing tasks and meeting deadlines.
Overview
12
12
years of professional experience
Work History
Sr. Medicaid Segment/Plan Change Coordinator
Blue Cross Blue Shield of Arizona
01.2020 - Current
- Handle approximately 70 to 80 inbound and outbound calls for the Medicaid and Medicare member services department, the provider queue, provider portal queue & assist receptionist queue as needed.
- Handle Bilingual calls for BCBSAZ Spanish speaking members for all lines of business.
- Assist Medicaid and Medicare members with any issues with any demographic issues, AHCCCS inquires, discrepancy issues with accounts, prior authorizations issues or status, reassigning primary care providers, eligibility and benefit information, Coordination of benefits issues, care/case disease management referrals, grievances, health appraisals, material requests, billing questions, RX imbursement issues and Urgent RX inquiries.
- Assist providers with eligibility and benefit information, prior authorization inquiries, appeals, claims inquires, educating providers on health plan processes for all lines of business.
- Medicare trained and follow Medicare guidelines.
- Claims trained. Assist providers and third-party organizations with resubmission, reconsideration, appeals and claim escalations.
- Assist member's with any plan change request following Arizona Health Care Cost Containment System (AHCCCS) guidelines. Work alongside our Medical Director to determine the medical necessity of the plan change request. Research if member meets all requirements and if they qualify for medical continuity of care. Collaborate with health providers to obtain medical records for review. Handle any correspondences received from member and providers and mail out any letters to member.
- Help cover the provider portal queue. Return voicemails and answer email inquiries to resolve any issues with the providers accounts. Cover the receptionist queue as needed.
- Handle private health information and medical records following all HIPAA guidelines.
- HIPAA compliance.
- Shepherded change requests through process with appropriate documentation, schedule and cost oversight and facilitated request approval.
- Worked closely with end-users to gather feedback on implemented changes, using insights gained to inform future initiatives.
- Contributed to operations, financial and technical processes to drive innovative solutions.
- Streamlined change management processes by coordinating cross-functional teams and incorporating effective communication strategies.
- Created detailed reports on the status of ongoing projects, enabling leadership to make informed decisions about resource allocation.
- Improved customer satisfaction by addressing and resolving complaints efficiently.
- Participated in ongoing training opportunities to expand skillset and stay current on best practices for delivering superior support.
- Maintained detailed records of each interaction, ensuring accurate documentation for future reference or follow-up purposes.
- Built rapport with customers through personalized interactions, increasing their trust in the companies products or services.
- Provided timely feedback to management regarding potential areas of improvement within the department or organization as a whole.
- Collaborated with team members to achieve shared goals in improving overall customer experience.
- Maintained high levels of customer retention with proactive outreach initiatives.
- Contributed to process improvements by offering valuable input during team meetings and brainstorming sessions.
- Consistently exceeded performance metrics while maintaining a focus on providing excellent customer support.
- Worked closely with other departments when necessary to address interrelated concerns affecting customer experience.
- Streamlined communication channels for quicker problem-solving and increased customer loyalty.
- Managed multiple priorities under tight deadlines while remaining calm under pressure and delivering excellent results consistently.
- Used effective time management strategies to handle fluctuating workloads without sacrificing quality or accuracy.
Sr. Enrollment Representative
Smile America Partners
09.2017 - 01.2020
- Handled approximately 60 to 80 inbound and outbound calls for Medicaid, Medicare and private health insurance.
- Handled Bilingual calls for Spanish speakers.
- Communicated with parents or guardians effectively from various cities within the United States to enroll their children into the school dentist program.
- Handled private health information and verified dental insurance coverage using authorized health systems.
- Handled patients delicate information and patient payments as necessary.
- HIPAA compliance.
- Collaborated with cross-functional teams to develop targeted marketing strategies for prospective students.
- Exceeded enrollment goals consistently by utilizing data-driven decision-making and personalized outreach efforts.
- Processed documents and payments to complete enrollment procedures.
- Increased conversion rates of prospects to enrolled students through tailored follow-up strategies and personalized support services.
- Ensured compliance with federal, state, and institutional regulations by maintaining accurate records and staying current on policy updates.
- Updated, entered, and reviewed customer data.
- Communicated effectively via telephone, email, and in person with prospective customers.
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Communicated with people from various cultures and backgrounds on application process.
Cash Lead
Shoe Carnival
05.2019 - 07.2019
- Handled checkout procedures for customers making purchases by electronic scanning of merchandise to process sales.
- Maintained a well organized and cleaned work stations.
- Informed customers of storewide promotions and specials.
- Leader to front end employees and cashiers.
- Trained as an assistant manager to assist during a busy workday.
- Collaborated with team members to reach company goals and lead our retail store to success.
- Temporary Summer Job
- Managed daily cash flow for optimal efficiency, ensuring accurate counts and timely deposits.
- Successfully resolved payment discrepancies through diligent research and clear communication with customers or financial institutions as needed.
- Conducted regular audits of cash registers, ensuring accuracy in financial reporting and adherence to company policies.
- Increased customer satisfaction by efficiently handling cash transactions and addressing customer concerns.
- Addressed escalated customer issues promptly, resulting in increased customer retention rates and positive feedback.
Geek Squad Tech Support
Alorica Company
02.2017 - 09.2017
- Handled approximately 40 inbound calls for Geek Squad customers.
- Handled computer issues for customers.
- Helped resolve computer issues at a detailed fast pace.
- Empathize with customers to better understand customer issues and help with the best solution possible.
- Handled customer delicate information and customer payments as necessary.
- Skilled at working independently and collaboratively in a team environment.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Learned and adapted quickly to new technology and software applications.
AT&T Soft Collections Trainer & Management Support
Alorica Company
06.2016 - 02.2017
- Handled approximately 70 to 80 inbound and outbound calls for customers dealing with past due accounts.
- Collected payments of customers when necessary.
- Handled delicate customer payment information.
- HIPAA compliance
- Handled escalated calls in a professional manner.
- Assisted peers with difficult or upset customers. Researched accounts to provide the best solutions.
- Trained new employees.
- Mentored new hires, resulting in stronger staff development and increased productivity.
- Provided one-on-one mentoring to help individuals reach their full potential within the organization.
- Coached employees on best practices, providing constructive feedback to support their professional growth.
- Evaluated the effectiveness of training initiatives by tracking participant progress and gathering feedback for continuous improvement.
- Collaborated with subject matter experts to create accurate training content.
- Enhanced trainee engagement through interactive workshops and hands-on activities.
- Delivered dynamic presentations to facilitate learning and retention among diverse audiences.
- Streamlined processes for creating, updating, and distributing training materials, resulting in significant time savings for staff members involved in these tasks.
- Boosted training session effectiveness with integration of multimedia tools.
- Optimized training delivery schedules, accommodating diverse learning styles and work commitments.
- Provided coaching and mentoring to employees.
Grocery Cashier, Bakery Clerk & Baker
Los Altos Ranch Market
03.2014 - 04.2016
- Handled approximately 40 to 50 checkout procedures for customers making purchases, electronic scanning of merchandise to process sales, clean work stations, informed customers of storewide promotions and specials. Baked and packed approximately 30 products at a fast safe pace. Working together to lead the supermarket to success.
- Maintained up-to-date knowledge on store promotions and sales events, informing customers about potential savings opportunities.
- Supported overall store operations by performing various duties such as stocking shelves, organizing carts, and assisting with inventory control when necessary.
- Actively participated in employee training sessions to further develop skills and stay current on company policies and industry best practices.
- Strengthened communication skills through daily interactions with diverse clientele from varying backgrounds and cultures.
- Utilized product knowledge to assist customers in locating items throughout the store efficiently.
- Exercised attention to detail when verifying IDs for age-restricted purchases, adhering to legal requirements and company policies.
- Assisted customers with bagging groceries, ensuring proper handling of fragile items to minimize damages.
- Handled cash and credit card transactions accurately, maintaining a balanced cash register at the end of each shift.
- Developed strong relationships with regular customers by providing exceptional service consistently.
- Demonstrated excellent multitasking abilities by managing multiple registers during peak hours effectively.
- Supported management in monitoring inventory levels at cashier stations, ensuring adequate supplies for smooth operations.
- Assisted coworkers during busy periods by taking over additional registers or tasks as needed, fostering a supportive team environment.
- Resolved customer complaints and inquiries professionally and courteously, providing solutions that satisfied both parties.
- Streamlined the checkout process for quicker transactions, resulting in shorter wait times for customers.
- Contributed to loss prevention efforts by vigilantly observing customer activity and reporting any suspicious behavior to management promptly.
- Pleasantly greeted customers and provided prompt and courteous service.
- Cleaned and maintained store aisles and merchandise displays to provide customers with positive experience.
Packer (PHX6)
Amazon.com
11.2014 - 01.2015
- Learn and adhere to strict safety, quality and production standards.
- Received products using radio frequency scanners.
- Packed and shipped approximately 60 to 80 customer orders with the mindset of customer obsession rather than competitor focus, passion for invention, commitment to operational excellence and long-term thinking.
- Adhere problem-solving skills.
- Proved successful working within tight deadlines and a fast-paced environment.
- Managed workload effectively under pressure during peak periods while maintaining focus on quality control measures.
- Complied with safety, health, and environmental regulations as prescribed by law.
- Complied with company policies and industry regulations throughout all packing activities, promoting a safe working environment.
- Ensured timely completion of orders through effective time management and multitasking skills.
- Completed all assigned tasks promptly, adhering to strict deadlines while maintaining high-quality workmanship.
- Enhanced packing efficiency by implementing proper techniques and ensuring correct product placement.
Picker (PHX6)
Amazon.com
10.2013 - 01.2014
- Learn and adhere to strict safety, quality and production standards.
- Received products using radio frequency scanners.
- Picked approximately 70 to 90 customer orders on a multi-level mezzanine with the mindset of customer obsession rather than competitor focus, passion for invention, commitment to operational excellence and long-term thinking.
- Adhere problem-solving.
- Worked fast to meet assigned daily picking quotas.
- Pulled orders quickly to maintain demanding productivity goals.
- Maintained a clean and organized warehouse, ensuring easy access to products for efficient picking.
- Expedited the picking process for faster order fulfillment using handheld scanners and inventory management software.
- Used RF scanners to track orders and verify accuracy.
- Verified proper labeling and identification on all orders before shipment.
- Scanned and verified UPC codes for all products to aid in identification.
- Assisted in reducing product damage through careful handling of items during the picking process.
- Demonstrated flexibility in adapting to various shifts and schedules while maintaining consistent performance standards throughout periods of increased workload demands or personnel shortages.
- Contributed to a safe working environment by adhering to safety protocols and reporting any hazards or issues promptly.
- Followed safety protocols and procedures to minimize workplace accidents.
- Took on extra hours and shifts during busy periods to meet tight shipping deadlines.
Education
Bachelor of Science - Health Science in Professional Development And Advanced Patient Care
Grand Canyon University
Phoenix, AZ10-2024
High School Diploma -
Maryvale High School
Phoenix, AZ05-2013
Skills
- People management
- Operational excellence
- Customer focus
- Workflow optimization
- Multitasking Abilities
- Problem-solving abilities
- Effective communication
- Adaptability and flexibility
- Professionalism
- Relationship building
- Teamwork and collaboration
- Organizational skills
LANGUAGES
English; Spanish (Bilingual)
Timeline
Sr. Medicaid Segment/Plan Change Coordinator
Blue Cross Blue Shield of Arizona
01.2020 - Current
Cash Lead
Shoe Carnival
05.2019 - 07.2019
Sr. Enrollment Representative
Smile America Partners
09.2017 - 01.2020
Geek Squad Tech Support
Alorica Company
02.2017 - 09.2017
AT&T Soft Collections Trainer & Management Support
Alorica Company
06.2016 - 02.2017
Packer (PHX6)
Amazon.com
11.2014 - 01.2015
Grocery Cashier, Bakery Clerk & Baker
Los Altos Ranch Market
03.2014 - 04.2016
Picker (PHX6)
Amazon.com
10.2013 - 01.2014
Bachelor of Science - Health Science in Professional Development And Advanced Patient Care
Grand Canyon University
High School Diploma -
Maryvale High School
Awards
- Certificate of Completion Ace-Plus Program 2011-2013
- Certificate of Achievement-College of Medicine Med-Start Program Summer of 2012
- Certificate of Arizona Skill Standards/Early Childhood Education-Spring 2012
- National Honors Society Certificate 2012-2013
Similar Profiles
Rene LewtonRene Lewton
Team Lead on the FEP Team at Blue Cross Blue Shield of ArizonaTeam Lead on the FEP Team at Blue Cross Blue Shield of Arizona
Brent LitsterBrent Litster
Lead Business Intelligence Developer at Blue Cross Blue Shield of ArizonaLead Business Intelligence Developer at Blue Cross Blue Shield of Arizona
Tong RuanTong Ruan
Customer Care Advocate at Blue Cross Blue Shield of ArizonaCustomer Care Advocate at Blue Cross Blue Shield of Arizona
Cyndos AlhadiCyndos Alhadi
Hygiene Assistant at Refresh DentalHygiene Assistant at Refresh Dental
Dylan HollinsDylan Hollins
Office Administrator at Cornerstone CaregivingOffice Administrator at Cornerstone Caregiving