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Candidate's Name
PHONE NUMBER AVAILABLESan Antonio, TX Street Address
EMAIL AVAILABLEEDUCATIONASSOCIATES of BUSINESS DEGREESt. Philips CollegeUS ARMYHIGH SCHOOL DIPLOMAAC Jones High SchoolPROFESSIONAL PROFILEProactive, self-motivated healthcare worker with 11 years of medical and insurance experience, seeking a healthcare position that will allow me to fully utilize my communication, organizational, and problemsolving skills as well as having the opportunity to expand my knowledge in new areas.EXPERIENCEPHARMACY HELP DESK ASSOCIATEContinuum Global (Sept 2022-current)Answer Inbound Calls from Customers and Address Questions & ConcernsProvide information about member pharmacy coverage & benefitsMake outbound calls to customers, Insurance and/or Doctor's office as needed to verify eligibilityResolve concerns to simplify member healthcare experienceNavigate through multiple computer applications with speed & accuracyAbility to adjust schedule as needed when volume of work business needs changeSALES REPRESENTATIVEAll School Fundraising / San Antonio, TX / Jan 2014  March 2015Outbound calls to companies to offer advertising on various items given out at school events to all schools to gain funds for various projects.Outbound calls to businesses and private individuals to solicit sales for goods and services, and to request donations for charitable causes.Provide explanation of products and services. Provide prices of products, and answer questions from customers.Data entry of orders for fulfillment to customersCUSTOMER SERVICE REPRESENTATIVECalling Solutions / San Antonio, TX / Sept 2005  Oct 2007Resolve customers' service and billing complaints by performing activities such as exchanging merchandise, refunding money, and adjusting bills.Complete contract forms, prepared change of address records, and issue service discontinuance orders, using computers.Contact customers to respond to inquiries and to notify them of claim investigation results or any planned adjustments.Solicit sales of new and additional services and products.Order tests that could determine the causes of product malfunctions.Provide ongoing analyses in areas such as transportation costs, parts procurement, back orders, and delivery processes.Prepare reports on logistics performance measures. -Conferred with logistics management teams to determine ways to optimize service levels, maintain supply chain efficiency, and minimize cost.Remotely monitor the flow of vehicles and inventory, using Web-based logistics information systems to track vehicles and containers.Business contractual requirements and guidelines to include timely data entry in MSR.Complete and document in MSR accurate and timely determinations of appropriateness of level of care: take appropriate actions to facilitate direction of patients to correct level of care as indicated by criteriaKnowledge of the various coding system: ICD-9, CPT and HCPCS codes.Receive document and resolve customer inquiries by using established best practices.Educate customers, providers and employers about Humana's products and services over the telephone.KEY SKILLSMedical TerminologyMicrosoft Word, Outlook and PowerPointClient Relations/Customer ServiceRelationship BuildingDetail OrientedResults DrivenInsurance Verification & AuthorizationsTime ManagementAdaptabilityData Entry50+ WPMREFERENCESREFERENCES AND LETTERS PROVIDED UPON REQUESTEXPERIENCE CONT.AUTOMATED LOGISTIC SPECIALISTUS Army / Sept 2005  Oct 2007Maintain databases of logistics information.Interpret data on logistics elements, such as availability, maintainability, reliability, supply chain management, strategic sourcing and distribution, supplier management, and transportation.Provide ongoing analyses in areas such as transportation costs, parts procurement, back orders, and delivery processes.Prepare reports on logistics performance measures. -Conferred with logistics management teams to determine ways to optimize service levels, maintain supply chain efficiency, and minimize cost.Remotely monitor the flow of vehicles and inventory, using Web-based logistics information systems to track vehicles and containers.