Customer Service Insurance

Al Jurado

Health and Benefit Coordinator (ACA)

El Paso, TX 79925

*.*****.******@*****.*** - 480-***-****

Licensed Insurance Agent (Producer) for Life and AD&D. Licensed in multiple states AR, GA, FL, IL, IN, MS, OH, TX, WA Authorized to work in the US for any employer

WORK EXPERIENCE

Health and Benefits Licensed Agent

HGS USA - Centene-Ambetter Health - El Paso, TX - September 2016 to Present Responsible for handling inbound and outbound calls with potential customers to identify needs and sell available Client health insurance solutions.

Research, document, and attempt to resolve all inquiries during the call. Provide quotes, answer questions, cross-sell ancillary products in accordance with established company policy and insurance guidelines.

Responsible for maintaining services that customers are attempting to cancel through product knowledge and negotiation techniques.

Handle customer service related issues to meet the needs of the clients and their customers. Provide accurate data entry of customer’s information for processing of sales orders, follow up and literature requests.

Follow up with potential clients via mail, email or phone as per customer request. Remain knowledgeable of Health Insurance industry changes with ongoing training in order to provide excellent customer service and improve your sales presentation and close ratio. Maintain performance in accordance with department guidelines to ensure the highest level of quality to our clients and their customers.

Respond positively and professionally to inbound and outbound calls and email related to new and existing accounts, for both external and internal customers. As a Licensed Agent Representative we Ensure high levels of customer satisfaction.

Property Manager Assistant

Anycasa Realty - El Paso, TX - October 2013 to Present Health and Benefit Account Coordinator

Insight Global-ADP Inc. - El Paso, TX - May 2016 to July 2016 RESPONSIBILITIES:

• Provide customer support including, but not limited to client set up, client questions and concerns related to benefits, eligibility, claims, renewal activity, quoting additional lines of coverage and calculation of employee deduction amounts for Group Health coverage.

• Act as a subject matter expert and single point of contact.

• Investigate, research, analyze and resolve complex issues and advice clients based on extensive group health insurance product knowledge.

• Develop and maintain effective communication to ensure satisfaction and world class service.

• Conduct welcome calls and scheduled service calls.

• Achieve and maintain agreed upon levels of service

• Follow up on carrier past due notices.

• Work with Regional Insurance Executive to achieve team goals

• Provide Tier 1 customer support

• Respond to basic inquiries regarding ADP products

• Resolve routine customer concerns with pre-defined solutions

• Handle customer inquiries that could require data entry changes

• Answer non-technical questions regarding ADP products and questions that cannot be handled by associate specialists as appropriate

• Learn and navigate ADP systems in order to respond to issues Medicare Customer Service Representative

Blue Shield of California - October 2013 to October 2015 Certified in HIPPA and PHI Regulations

Medical Billing and Procedure Codes

CPT, ICD-9 and UB-04 and EOB (Eligibility of Benefits)

● Responsible for assignments that range from routine to complex in nature.

● Resolving complex issues dealing with co-payments, co-insurance, deductibles, in and out of network providers and facilities (ex. Urgent care Centers, Clinics and Hospitals)

● Resolve various customer inquiries via telephone and correspondence, and resolve claims problems within established production and quality standards.

● Answers incoming calls and written requests for information from members, providers and brokers promptly and accurately.

● Composes routine and non-routine correspondence to answer member inquiries that require a written response. Coordinates with other departments to ensure timely and appropriate responses.

●Expedites and resolves complex issues and initiates claim adjustments

●Educates others on the Blue Shield product, providing accurate information and updates to policies, facilities and procedures, improving overall customer satisfaction.

●Capable of effectively navigating through multiple platforms or applications to efficiently locate information and complete processing task.

Sales Representative

DIRECTV - El Paso, TX - July 2012 to August 2013

Responsibilities: To serve as the main source of contact, providing excellent service to DirecTV customers, anticipate the customer's needs and resolve the majority of the customer's issue's.

• Offer promotional incentives and provide additional sales opportunities

• Identify customer needs and provide resolution to problems and inquiries

• Capture data and enter clearly and accurately

• Use customer service skills to appropriately satisfy and retain customer

• Escalate call appropriately

Customer Service Advocate

Prescription Solutions - El Paso, TX - October 2010 to June 2012 Maintains the National Practitioner Data Bank to include inputting of data and all inquiries made of the system, in accordance with applicable regulations and guidelines.

● Manages, administers, and maintenance and operation of database systems.

● Assures provider enters and submits credentialing information into the credentialing system, providing assistance and training, and analyzes and prepares program status reports.

● Performs complete credentialing process in credentialing system, of all credentialed providers including retrofit of paper files to electronic files.

● Assumes responsibility for maintaining all appropriate handbooks, manuals, directives, circulars and bulletins regarding the credentialing program.

● Retains responsibility for the credentialing files of all licensed, registered, and certified health care professionals, maintaining files.

● Coordinates internal resolution of claims exceptions and other issues

● Monitors use of business resources, is a credit card holder that maintains records, reconciles monthly charge statements, and verifies legitimacy of requests.

● performs other related duties as assigned.

● Answers incoming calls; assists customers/pharmacies/physicians with orders and reorders, benefit eligibility questions and prescription status inquiries. Escalates drug related calls to appropriate pharmacist

● Assist pharmacies and members on all issues related to processing of pharmacy claims. Determines appropriateness of overriding pharmacy claims edits and error message.

● makes outbound calls on prescriptions with hold orders and payment issues

● Educates customers on benefits, use of plan, formulary, premiums and status of orders, claims or inquiries. Mortgage Home Mortgage Consultant

Wells Fargo Home - El Paso, TX - July 2009 to September 2010 Originate high quality loans which meet WHFM guidelines while providing excellent customer service

●Analyze detailed financial and credit data, matching customer needs with an appropriate loan program and level of risk

●Receive customer applications, quote the rate and follow-up activities with the registration lock-in

●Develop knowledge of company products, policies and procedures, requirements relationships with other business referral source

●Perform miscellaneous duties as needed and required Mortgage Broker

Meticulous Mortgage LLC - Gilbert, AZ - November 2004 to February 2009 Mortgage Loan Financing

●Originate and process loans for VA, FHA, Residential and Commercial lending.

●Determine borrower's creditworthiness, and help guide through the process. Advise the client of different Rates and financing available

●Work with Title Companies to ensure timely closing. Preferred Accounts Coordinator

DHL Worldwide Express - Tempe, AZ - October 2001 to October 2005 Single point of contact for high revenue accounts.

●Tracking and tracing, proactive monitoring, bill collection for Duty/Taxes and VAT, customized reporting, and special pick-up arrangements for both International and Domestic shipments.

●•Familiar with U.S. Custom rules and regulations, NAFTA rules of origin, and the classification and valuation of merchandise according to the Harmonized Tariff Schedule (HTS, and CFR)

●Perform assignments and process work to meet established deadlines and performance goals. Account Representative/Collections

Jacobo Wholesale - El Paso, TX - December 1999 to April 2001 Communicate with customers daily to set-up delivery

●Establish incoming merchandise and set-up of out going shipments.

●Maintain bookkeeping and payment arrangements.

●Collections-Coordinate payments, and arrange of overdue accounts EDUCATION

Bachelor of Art in International Business Trade

El Paso Community College

University of Advanced Computer Technology - Tempe, AZ EPCC-El Paso Community College - El Paso, TX

J.M. Hanks High School - El Paso, TX

CERTIFICATIONS/LICENSES

Licensed Insurance Agent

September 2016 to September 2018

Licensed in AR, GA, FL, IL, IN, MS, OH, TX, WA

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