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Click here or scroll down to respond to this candidateCandidate's Name
Street Address PHONE NUMBER AVAILABLE EMAIL AVAILABLEObjective EducationProfessional Customer Service Representative committed to providing courteous, prompt, detailed and accurate support, in a busy, fast paced call center. Detail oriented and proactive with good communication skills, a hardworking nature and an adaptable approach.Lamson InstituteMedical Lab Tech Diploma2009Frank TejedaHigh-school Diploma2008ExperiencePROGRAM COORDINATOR MINDLANCE SEPTEMBER 2023- FEBRUARY 2024Coordinated and initiated DME referral requests for Superior HealthPlan Star Plus members.Screened for eligibility and benefits. Screened members by priority for case management (CM) assessment.Performed transition of care duties to include but not limited to contacting the members attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.Provided education to members regarding DME benefits and DME requirements.Assited with finding DME providers, calling members PCP to ensure DME MD orders were obtained, and all requirements are met for an authorization.Follow-up with member to confirm needed DME item(s) were delivered and confirm satisfaction with DME item.MEDICARE CUSTOMER ADV0CATE AETNA SEPTEMBER 2017- JULY 2023Provided support and rendered Excellent Customer Service by addressing all Group Medicare Advantage member calls related to inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, status of authorizations for medical care, grievance/appeal status.Updated member information, including demographics and contacts made with customers/providers within gps system.Provided support, guidance, direction & limited education to providers on member eligibility, authorizations, provider claim issues.Prepared and submitted expedited appeals on denied prior auth requests for providers and members.Coaches, trains and assists in the development of call center staff, as required.Trace checks for providers and/or participants handled payment issues within billing department and claims department.Assisted escalation team with overflow of escalations.Troubleshoot issues with member portal (username, password, navigating site)CUSTOMER SERVICE REP TXTAG 07/2016 - 03/2017Answer Inbound Calls from customers with questions concerning and/or related to their account.Acknowledge and resolve customer complaints and difficult situations.Process required transactions via web-based applications.Maintain a thorough knowledge of the company and client programs, policies, and technology.Communicate effectively in a warm and empathetic manner.Adhere to confidentiality requirements and laws to ensure information is disseminated only to authorized individuals.Troubleshoot issues with member portal (username, password, navigating site)CUSTOMER SERVICE REP QVC 10/2015 - 03/2016Answer inbound calls and assist customers with questions, /concerns regarding their accounts.Aided customers in making informed purchase decisions and product selections.Verified account information in the system was up to date and accurate, updated info as needed.Provided direction and constructive feedback to motivate team members.Handled customer complaints and processed requests for product returns/replacements.Processed credit card payments and offered self-serve payment options after explaining charges on customer bills.Assisted escalation team with escalation follow ups.SkillsPrior experience interpreting Member Benefits and Medicare ClaimsProficient in Microsoft Office (Outlook, Excel, Word.)Strong technical skills with the ability to work across multiple software systemsSelf-motivated and able to work independently, while also collaborating effectively within a teamEmpathetic and CompassionateExcellent oral & written communication skillsStrong problem-solving skills and the ability to troubleshoot technical issuesCustomer Service or call center ExperienceIntegrity and discretion to maintain confidentiality of members HIPAA dataAdaptabilityReferral coordination |
