Customer Service Health Care
Resume:
Camille Soto Alicea
Haines City, FL *****
*************@***********.***
Dynamic, service-driven administrative professional adept managing multiple responsibilities in a fast paced environment where planning, organization, prioritization and communication skills are key. Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
Appeals and Grievances Case Set up Specialist
Optum - San Juan, PR
August 2022 to Present
As a case set up specialist. We must use critical thinking in order to determine if an appeal, a grievance or disputed claim received from a provider or subscriber can be considered for a reconsideration or the payments or rejection of claims.
Member Engagement Representative
TRIPLE S ADVANTAGE - San Juan, PR
June 2015 to August 2022
Make outbound calls to all of our Health care plan members to complete different types of surveys as cancellation, disenrollment, follow up and quality based on their experienced such as help them with their inquiries, complaints, grievances and fulfill their needs with excellent customer service following the Center for Medicare and Medicaid Services standard procedures reaching 100 % percent of quality in every call.
Complete changes of health plan coverages during the Annual Enrollment Period and in Open Enrollment Period, work with providers claims, disputes, appeal and grievances procedures. Customer Service
Humana Medicare Health Care a XEROX ACS company - Guaynabo, PR June 2012 to May 2015
Work in fast paced environment receiving calls of our English speakers customers living in the United States; help them with their inquiries, their grievances and appeals and invoices claims, taking payments and reaching 100 % percent of quality in every call. Telemarketer
Gran Melia Hotel Vacation Club - Río Grande, PR
December 2008 to April 2012
Promote vacation club program via cold calling and telemarketing activities. Qualify prospects and offer them attractive vacations. Constantly overcome the monthly production. Achievements
2008 Top Sales Telemarketing
Education
Bachelor Degree in Social Science
Universidad de Puerto Rico Recinto de Río Piedras - Rio Piedras, PR January 1997 to June 2003
Associate Degree in Secretarial Science
Colegio Universitario de San Juan - San Juan, PR
January 1994 to December 1996
Skills
• Fully bilingual English and Spanish, knowledge and domain of Microsoft Programs Word, Excel and Power Point. Typing skills 60-75 word for minutes. (10+ years)
• Triage
• Cold Calling (10+ years)
• Telemarketing (10+ years)
• Administrative Experience
• Computer skills
• Communication skills
• HIPAA
• Typing
• Customer service
• Microsoft Access
• Windows
• Sales
• Data entry (9 years)
• Bilingual
• English
• Spanish
• Microsoft Office
• Retail sales
• Hotel experience
• Medical terminology
• Administrative experience
• Medical office experience
• Organizational skills
• Phone etiquette
• Office experience
• Cold calling
• Cash handling
• Guest services
• Restaurant experience
• Cash register
• Microsoft Excel
• Computer networking
• Analysis skills
• CRM software
Languages
• Spanish - Fluent
• English - Fluent
Certifications and Licenses
Camille Soto
September 2020 to August 2026
Driver's License
September 2020 to August 2026
Additional Information
Got promoted in Optum from Appeals and Grievances for Medicaid to Behavioral Health Appeals and Grievances on November 6 2023. Knowledge in Facets, Macess, Icue, Linx, Iset, Aset and ETS.
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