Service Representative Customer

Mia Guzman

** ******* *** *****, ******* *****

404-***-**** *******@*****.***

Experience

Elevance Health: Blue Cross Blue Shield

Customer Care Representative

**/**** - *******

•Record and report member grievances and complaints to providers.

•Informed members of all included benefits with the EAP program.

•Escalated calls to correct staff when needed to stay within HIPAA compliance.

•Assist members with finding a provider within the network.

•Answer inbound high-volume calls from members and providers.

•Provided claim information to providers

Teleperformance

Provider Service Representative

10/2020 - 05/2021

•Answered high-volume inbound calls from Providers and their staff calling into Peach State

Medicare and Medicaid plans.

•Assisted providers with utilizations.

•Informed providers if they were or weren't within the network.

Broadpath

Healthcare Customer Service Representative/Mentor

10/2018 - 10/2020

•Promoted to mentor and guided new CSR employees during their nesting period to assist with their call flow and finding information in the correct systems.

•Informed members of their benefits, including co-pays, deductibles, and coinsurance.

•Informed members of Providers within the Network.

•Answered inbound calls from members of Ambetter health insurance.

The HCI Group

Epic Consultant

05/2014-09/2018

•Provided support to various hospital staff implementing Epic with a focus on Cadence and Obstetrics

•Was chosen to lead a few teams of up to 12 on various Epic implementations

•Maintained HIPAA compliance when dealing with providers and staff when assisting patients in the facility

The Brownstone Project

Clinical Assistant

03/2011 - 01/2014

•Maintained patient charts to ensure compliance.

•Promoted from front desk receptionist to clinical assistant and worked directly with mental health staff.

•Performed quality audits on patient charts.

•Scheduled appointments with the psychiatrist.

•Coordinated patient contact regarding appointments with mental health staff.

Education

University of Phoenix

Bachelor’s of Psychology

2023-Present

Hiram High School

High School Diploma

2004-2008

Skills

• Customer Service with a focus on healthcare

• Proficient experience and knowledge of HIPAA

• Type 65 WPM

• Proficient experience in the use of Microsoft Office

• Proficient knowledge of medical terminology and health insurance benefits

Contact this candidate