Customer Service Representative with 5+ years of experience using excellent communication skills, strong de-escalation experience, and ability to learn and retain knowledge quickly to assist customers in resolving questions and issues. Varied experience in both food service, healthcare, and corrections has equipped me with the ability to use a wide variety of skills to get the job done.
SEPTEMBER 9, 2021 – FEBRUARY 2, 2024
Customer Service Representative Tier 4/Sagility Healthcare WFH
Answered large number of incoming calls for both Humana Medicare members and providers.
Reviewed benefits and located providers for members
Reviewed claims and compared to benefits to ensure all claims are being paid correctly
Use CRM to locate members accounts and accurately document all calls
Submitted appeals for prior authorizations received by both members and providers. Gave status and gave next steps when needed.
Completed provider credentialing by using primary source verification, such as SAMS, DEA, CAQH
Reached out to providers and members when more information was needed to resolve issue.
Used training and database researched to educate members on their benefits and Healthcare plans.
Assist members with billing related concerns.
APRIL 2016– AUGUST 2020
Correctional Officer IV/Texas Department of Criminal Justice, Beeville, TX
Maintained custody and control of offenders
De-escalated conflicts between offenders, offenders and staff, and staff
Addressed inquiry from staff, offenders, offender’s family, and general public
Prepared and maintains logs, reports, and records
Kept track and issued all keys and equipment
Worked within tight policies and procedures to maintain a controlled and safe environment.
OCTOBER 2013 – OCTOBER 2015
Customer Service Representative/McDonald’s, Beeville, TX
Trained new employees
Greeted customers and provided excellent service
Completed cash and card payments when necessary.
Proficient with Microsoft applications such as PowerPoint, Word, and Excel
Excellent time management skills
Fast learner and ability to adapt and retain knowledge
Multiline phone proficiency
Suicide prevention training.
Associates of Science/Coastal Bend College, Beeville, TX