Customer Service Insurance
Resume:
Sofia M. Ospino
Miami, FL *****
***********@*****.***
An intelligent, adaptable, logical thinking, motivated individual, with good organizational and communications skills, looking to forward her career in the medical sector
Professional / Accredited training:
ICD-9 &10
CPT
HCPCS
Blood borne Pathogens
OSHA
Notary Signing Agent
Billing Compliance
Coding Compliance
CPR
HIPAA Safety
Medical Billing Certification
Certified Notary Public of Florida
Education & Affiliation:
Florida Insurance University Pursing 440 License
Med Vance Institute NCCT and CPC Certifications
Miami Dade Community AA in Business Administration
South Florida International High School
1/2015- current : Bupa Job Title: Customer Service Rep.
Evaluates preauthorization requests from providers and customers. Deliver personalized service and provide support to brokers, providers and policy holders. . Identifies and resolves member claims and customer questions, concerns or complaints with a sense of urgency in order to ensure customer satisfaction.
Manage claim requests, notification and preauthorization questions via phone and email from members and providers within given deadlines and service objectives.
Sends letter of authorization or denial and explanation of benefits depending on the treatment evaluation.
Enters notes for every conversation, email and decision in the system so that it is available Companywide.
Handles calls and emails from Business Partner’s, Brokers, Members and Service Centers within department expectations to meet company service objectives
Resolves questions and issues concerning delays in new business applications, requests.
Delivers personalized customer care to brokers and Policy holders by resolving issues personally, regardless of the question or issue, calls back with information or resolution within set deadlines, exceeding customer expectations.
Handles questions or claims issues for policies.
Able to identify an incorrectly processed claim (i.e. incorrect case handling, payments and diagnosis) and able to cross reference claims among systems.
May receives visits from Policy holders visiting Miami.
Supports the call center staff in order to meet customer service Key Performance Indicators.
Documents all communication in the system to ensure access for everyone.
Handles request for proof of insurance.
Performs other related tasks as assigned.
4/2013- 5/2014: Orange Insurance Group Job Title: Customer Service Rep.
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Handle large volumes of incoming outgoing calls daily
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Handle Endorsements/Set-up Policy Review Appointments
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Quote Homeowner and Car Insurance and cross-sell
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Make telephone Prospecting/cold-calling
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Manage accounts by tracking and following up frequently
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Input all information into proprietary software system
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Work effectively within assigned team and other teams in the department
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Provide high level of customer service to both internal and external customers
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Perform other job-related duties and responsibilities as assigned
10/2008-4/2013: NGN Engineering Job Title: Client Consultant
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Responsible for organizing, coordinating and establishing client operational needs.
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Client visit (both established and potential clients.
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Maintain, generate leads, interact with clients, contract negotiations,invoicing and payment collection.
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Supervise and develop implantation of staffing strategies.
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Monitoring, mentoring and evaluating the performance of team members.
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Respond to incoming enquiring and action leads obtained in timely and professional manner.
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Research incoming leads and existing clients to identify market opportunities and inform company’s service
1/2007 – 10/2008: ADP Total Source Job Title: Employee Service Center Representative
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Resolve benefits, payroll and 401(k) issues at first point of contact with employees.
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Act as a liaison with other departments, carriers and providers.
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Document calls to ensuring proper follow up and resolution of issues.
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Keep up-to-date of new products/technology.
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Be knowledgeable on all insurance plans offered nation-wide.
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Work Collection Report of Employers in effort to collect outstanding bills.
5/2005 – 2/2006: Bank of America Job Title: Teller Service Specialist
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Processed transactions accurately and efficiently in accordance with established policies.
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Balanced cash fund daily.
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Completed over/short adjustments and sent totals to operations department.
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Prepared, sorted, and distributed reports to appropriate branches.
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Supplied other tellers with coin and currency as needed.
10/2003- 5/2005: Preferred Care Partners Job Title: Member Service Representative
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Act as liaison between patients and the health care organization,
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Primary role to provide excellent patient service
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Quickly identifying patient needs and work to resolve issues in a friendly, professional manner.
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Determining if an issue requires escalation to the next level.
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Interacting with team members and other departments and employees of other organizations.
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Handle mail processing for new members and member discontinuing coverage.
10/2001 – 10/2003: Beckman Coulter Job Title Customer Support Specialist
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Duties included answering customer queries, problem solving and providing detailed information on new products.
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Worked with new customers in the development of new accounts and the implementation of new systems.
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Assisted in the development of new policies and procedures.
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Assisted in the training of new customer service representatives and associates.
8/2001 –10/2000: Orkin Pest Control Job Title: Bookkeeper/Admin. Assistant
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Responsible for account allocation, inter-company invoicing, daily bank deposit prep, payment posting and wire transfers.
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Handle account receivable, billing and collection calls for services rendered.
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Performed general office duties such as filing, faxing and answering phones.
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Worked to together with technicians to provide information on suspended and active accounts.
References: Available upon requested
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