Crystal Aguero

**** ***** **** *** *******, Tx **227 210-***-**** ad42jf@r.postjobfree.com

Objective Education

Professional Customer Service Representative committed to providing courteous, prompt, detailed and accurate support, in a busy, fast paced call center. Detail oriented and proactive with good communication skills, a hardworking nature and an adaptable approach.

Lamson Institute

Medical Lab Tech –Diploma

2009

Frank Tejeda

High-school Diploma

2008

Experience

PROGRAM COORDINATOR MINDLANCE SEPTEMBER 2023- FEBRUARY 2024

Coordinated and initiated DME referral requests for Superior HealthPlan Star Plus members.

Screened for eligibility and benefits. Screened members by priority for case management (CM) assessment.

Performed transition of care duties to include but not limited to contacting the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.

Provided education to members regarding DME benefits and DME requirements.

Assited with finding DME providers, calling members PCP to ensure DME MD orders were obtained, and all requirements are met for an authorization.

Follow-up with member to confirm needed DME item(s) were delivered and confirm satisfaction with DME item.

MEDICARE CUSTOMER ADV0CATE AETNA SEPTEMBER 2017- JULY 2023

Provided support and rendered Excellent Customer Service by addressing all Group Medicare Advantage member calls related to inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, status of authorizations for medical care, grievance/appeal status.

Updated member information, including demographics and contacts made with customers/providers within gps system.

Provided support, guidance, direction & limited education to providers on member eligibility, authorizations, provider claim issues.

Prepared and submitted expedited appeals on denied prior auth requests for providers and members.

Coaches, trains and assists in the development of call center staff, as required.

Trace checks for providers and/or participants handled payment issues within billing department and claims department.

Assisted escalation team with overflow of escalations.

Troubleshoot issues with member portal (username, password, navigating site)

CUSTOMER SERVICE REP TXTAG 07/2016 - 03/2017

Answer Inbound Calls from customers with questions concerning and/or related to their account.

Acknowledge and resolve customer complaints and difficult situations.

Process required transactions via web-based applications.

Maintain a thorough knowledge of the company and client programs, policies, and technology.

Communicate effectively in a warm and empathetic manner.

Adhere to confidentiality requirements and laws to ensure information is disseminated only to authorized individuals.

Troubleshoot issues with member portal (username, password, navigating site)

CUSTOMER SERVICE REP QVC 10/2015 - 03/2016

Answer inbound calls and assist customers with questions, /concerns regarding their accounts.

Aided customers in making informed purchase decisions and product selections.

Verified account information in the system was up to date and accurate, updated info as needed.

Provided direction and constructive feedback to motivate team members.

Handled customer complaints and processed requests for product returns/replacements.

Processed credit card payments and offered self-serve payment options after explaining charges on customer bills.

Assisted escalation team with escalation follow ups.

Skills

Prior experience interpreting Member Benefits and Medicare Claims

Proficient in Microsoft Office (Outlook, Excel, Word.)

Strong technical skills with the ability to work across multiple software systems

Self-motivated and able to work independently, while also collaborating effectively within a team

Empathetic and Compassionate

Excellent oral & written communication skills

Strong problem-solving skills and the ability to troubleshoot technical issues

Customer Service or call center Experience

Integrity and discretion to maintain confidentiality of member’s HIPAA data

Adaptability

·Referral coordination

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