Manuel Morales López

Bilingual Registered Nurse (BSN) and healthcare operations professional with extensive experience supporting health insurance organizations and clinical environments. Proven track record in coverage processing, service coordination, clinical documentation review, and healthcare administrative operations. Skilled in evaluating member service requests against coverage guidelines, medical data management, regulatory compliance (ASES/CMS), and cross-functional team communication within highly regulated healthcare environments.

IT Technician - Grupo Roelsa

(2021-11)

• Perform physical migrations, cabling, installation, and network troubleshooting for operational technology and data systems.
• Maintain data integrity, system security, and technical functionality across high-volume operational hardware and software environments.

Prenatal Coordinator - MMM HEALTHCARE - Puerto Rico

(2015-03 - 2021-10)

• Coordinated prenatal healthcare services and managed authorization requests for specialized care within a regulated health insurance environment.
• Evaluated member clinical needs, verified coverage eligibility, and maintained meticulous documentation adhering to established healthcare quality protocols.
• Facilitated direct communication between members, clinical providers, and internal teams to ensure seamless care delivery and compliance.

Special Coverage Clerk - TRIPLE-S - San Juan, PR

(2014-10 - 2015-02)

• Provided administrative and clerical evaluation for special coverage authorization processes within a major health insurance environment.
• Processed medical documentation, verified benefit coverage parameters, and handled customer service inquiries from healthcare providers and members.

Operations Support Administrator - HUMANA - Puerto Rico

(2011-09 - 2013-09)

• Delivered high-level operational and administrative support for healthcare business operations and health plan administration.
• Maintained complex electronic data systems, member correspondence, and clinical documentation records.
• Prepared and modified operational reports, including ASES audit documentation for the organizational Disaster Recovery Plan (DRP).

Customer Service - Face to Face - MEDICAL CARD SYSTEM - San Juan, PR

(2010-08 - 2011-10)

• Delivered direct in-person member services, assessed clinical and administrative needs, and resolved service-related inquiries.
• Applied service quality standards and problem-solving skills to navigate insurance coverage policies and maximize member satisfaction.

Support and Management Clerk - TRIPLE-C / CTS AGENCY - San Juan, PR

(2007-07 - 2010-08)

• Performed administrative, clerical, data-entry, file maintenance, and official correspondence duties in support of office operations.
• Provided accurate policy and procedural information to internal departments and external healthcare customers.

Bachelor of Science in Nursing - Nursing - NUC University (2020-08 - 2024-12)

Associate Degree in Computer and Information Systems Specialist - Computer and Information Systems - John Dewey College (2003-08 - 2005-05)