Maria B Alcala

our thinking, our behaviors, internally and externally. It is how we make important decisions and conduct ourselves every day as responsible members of healthcare and corporate communities. • M&R Certified levels 1 and 2, and 3. I have invested in myself to learn more about Medicare & Retirement so I can understand how my everyday work impacts the bigger picture. Have more detailed knowledge of Medicare terms and the language of the Medicare business. Gained exposure to information to light my innovation spark & I can more easily move faster from ideas to concrete execution to work for positive change in people's lives. • Refer claims to investigators for further review. My work does not usually require established procedures & gives me the freedom to "think outside of the box" to use all available resources to solve complex issues the member may have therefore they can focus on health concerns. • National Experience Center advocate servicing our members by the utmost courtesy and respect. Deliver one on one care to members that have or may have had ongoing issues. Use phone and email case assignment to solve any issues the member may encounter. • Expertise in customer service and support for our members as part of our UnitedHealthCare by directly phone-based interaction to address complex member needs and provide recommendations on services that may help close gaps in care for the member and/or members' family. Anticipates customer needs and proactively identifies solutions. • Full ownership of any obstacles that my member may face and stay with matter at hand until it is fully resolved to make matters hassle free for my member by navigating through systems ICUE, COSMOS, RXCLAIMS, UFE, ODM, EDSS. I also use said systems to verify any prior authorizations or referrals as needed. • Educate members on fundamentals and benefits of health care topics to include managing their health and well-being & maximizing the value of their health plan benefits and choosing a quality care provider and assist in navigating their proper UHC website for self-help options. Acts as a facilitator to resolve conflicts on team; seen as key team member on project teams spanning more than own function.