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Service Representative Customer

San Antonio, TX
March 05, 2018

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Professional Summary:

** ***** ** ********* ******* speaking call center experience handling up to 100 calls a day

** ***** ** ********** ********** in a managed care setting working with providers and Medicare/Medicaid recipients

Experience screening patients for eligibility and benefits as well as assisting members find providers within their area for services needed

Excel in listening to customer needs product benefits and creating solutions that provides value to the customer

Extensive experience building and maintaining enduring customer relationships to boost sales and generate repeat business

Professional Experience:

CGI Federal

September 2016 – Present (position is ending )

Bilingual Medicare/Medicaid Service Representative 9/19/2016 – Present

Working for the Commercial Repayment Center of Medicaid and Medicare Center

Receive inbound calls from members or their families regarding claim questions status of claims or documents needed for different levels of recovery status.

Help customers find providers that are in their network for services needed

Screen for eligibility and benefits


April 2015 – Aug 2016


December 2012 – March 2015

Bilingual Provider Benefit Specialist

Inbound/Outbound calls respond to telephone inquiries

Educated and answered insured/providers questions regarding dental benefits policies and procedures.

Delta Dental providing benefits and claims processing.

Processing dental claims

West Corporation

January 2008 – November 2012

Bilingual Customer Service Representative

Inbound/Outbound calls from telecommunication and customers

Performed different tasks and projects with this company Medco sales order processing and following with customers.

AT&T taking orders and setting up appointments for cable inland lines and internet.


July 2000 – March 2008

Bilingual Member Service Representative

Inbound/Outbound calls from Insured providers and facility taking medical insurance information opening files and obtaining medical information for precertification review.

Followed up with providers making sure all medical requirements was obtained to for utilization review.

Effectively analyzed detailed information and transforms into communicable reports both internally and externally in order to lower costs and increase profits

Maintained provider contract files and system information for the Medicare Advantage Program

Researched and solved provider issues;


Medical Billing and Coding Certificate Everest Institute – San Antonio TX

General Education Diploma Gwinnett Community College – San Antonio TX

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