Celine Jolteus

I’m a healthcare compliance and operations professional with 9 years of experience across Medicare Advantage and Medicare Part D, appeals and grievances processing, QA auditing, and CMS regulatory compliance. I’ve been recognized as a top performer—ranking number one Medicare enrollment advisor company-wide at Aon OneSource with a 98% Part D case resolution rate, and maintaining 100% audit compliance across CMS and HIPAA regulatory reviews at Alight Solutions.

I bring deep back-office expertise in appeals and grievances coordination, claims review, enrollment data auditing, eligibility verification, and QA monitoring. In remote roles, I monitored and scored agent interactions against CMS and HIPAA standards, delivered documented coaching feedback, and escalated violations with supporting evidence to ensure corrective actions met regulatory timeframes.

My approach is built on accuracy, root cause analysis, and measurable outcomes. I audited enrollment data across 200+ flagged applications, identified recurring data discrepancies, and protected data integrity by participating in UAT testing for platform rollouts before go-live. I also helped reduce processing errors by 12% through standardized procedures and contributed to SOP development to improve consistency across case types.

I’m currently completing CMS Medicare Learning Network certifications and maintaining an active Florida 2-15 Insurance Life and Health License with AHIP certification in good standing. I’m pursuing a Lean Six Sigma Yellow Belt to formalize process improvement—so I can continue driving compliance, operational performance, and reliable outcomes for healthcare organizations.