Customer Service Call Center
Resume:
Briana Barajas
Moreno Valley, CA *****
********@*****.***
Highly skilled and detail-oriented Employee Benefits Specialist/Division Support Specialist with a proven track record of exceeding service level call center expectations and delivering excellent customer service. With five years of experience, including four years of successful remote work, I have specialized in administering comprehensive benefits programs, focusing on HSA, FSA, COBRA plans, Medicare Part C, and wellness programs. My strong knowledge of benefits regulations and compliance requirements ensures accurate and efficient claim substantiation for voluntary benefits. I possess excellent communication and interpersonal skills, fostering effective collaboration with employers, employees, vendors, and management. As a dedicated healthcare advocate, I have assisted seniors with Medicare Part C, PCP, and Medical Group changes, guided members through open enrollment, facilitated supplemental benefits, and connected members with vendors. My proven ability to verify insurance coverage and liaise with primary care physicians' offices showcases my commitment to providing exceptional customer service and support. Work Experience
Member Service Specialist
SCAN Health Plan - Remote
September 2023 to February 2024
• Assisted seniors with Medicare PART C
• Facilitated PCP and Medical Group changes.
• Conducted plan changes during open enrollment.
• Connected members with appropriate supplemental benefits vendors.
• Verified insurance coverage by contacting primary care physicians' offices on behalf of members.
• Call center, exceeding SL using Genesys.
• Completed six-week training.
Division Support Specialist
D-125 - Remote
March 2020 to July 2023
● Administered and managed all aspects of employee benefits programs, including HSA, FSA plans, Medicare Part C, and COBRA administration.
● Developed strong knowledge of TPA industry regulations and compliance requirements.
● Specialized in claim substation and reimbursements.
● Demonstrated understanding of insurance processes and medical billing codes.
● Oversaw company's customer support email for the division, carrier communication email for COBRA, and consumer calls escalated by CSR team, addressing inquiries regarding elected plans, troubleshooting portal assistance, and claim support.
● Spearheaded a channel specific to my division for immediate customer service team assistance, resulting in one-call solutions for customers.
● Built a Knowledge Base as a tool for the Customer Service Team, providing training and quick access to information on HSA, FSA, Medicare Part C, and
COBRA plans.
● Managed and resolved a high volume of escalated customer service tickets, ensuring timely and effective resolution for diverse customer inquiries and concerns.
● Administered HSA custodial transfers.
● Collaborated with clients during implementation to ensure cost-effective benefit offerings.
● Developed and maintained wellness initiatives and education notifications, resulting in improved employee participation rates.
● Ensured compliance with federal and state regulations, including HIPAA, IRS Requirements, and ACA guidelines.
● Coordinated with external clients to resolve benefit-related issues and discrepancies, participating in scheduled meetings, emails, and calls to ensure client satisfaction.
● Accurately processed monthly COBRA premiums to COBRA Point.
● Prepared and distributed benefits communications, including plan summaries, enrollment materials, reinstatement confirmation for COBRA consumers, and generated reports for clients.
● Additional details: Well-versed in remote communication and collaboration tools, such as Slack, Teams, Monday.com, Genesys, and Five 9, call center experience, technical troubleshooting, time management, self-discipline, skilled collaborator, effective cross-functional communicator, solution- oriented professional.
Tier 2 Auditor
Clearify - Remote
January 2018 to January 2020
● Conducted detailed audits of employee dependents' eligibility for benefits.
● Verified documentation, conducted interviews, and analyzed data to ensure compliance with company policies and regulatory requirements.
● Collaborated with HR and Benefits teams to resolve discrepancies and implement corrective measures.
● Developed and maintained audit reports, documenting findings and recommendations.
● Assisted in the development and improvement of audit processes and procedures.
● Assisted in conducting audits of various client accounts.
● Provided valuable support to a high volume of phone calls daily.
● Managed client and customer support emails with swift response time, ensuring customer satisfaction.
● Performed data analysis and verification to identify discrepancies and potential risks.
● Prepared audit reports and communicated findings to senior auditors.
● Assisted in developing and implementing internal control measures. Guest Relations
Target Corporation - Riverside, CA
October 2014 to January 2018
● Provided excellent customer service with a friendly attitude.
● Enthusiastically addressed guests' inquiries.
● Replenished store shelves and ensured a clean and inviting workplace environment.
● Operated as a front-end cashier, processing transactions accurately.
● Ship from store lead.
● Maintained an organized, clean, professional workspace. Education
Associate's degree
Riverside Community College - Riverside, CA
Palm High School - Riverside, CA
Skills
• Teams
• Time management skills
• Carrier communications
• Documentation review
• Account management
• Excellent customer service
• Windows
• Strong communication and interpersonal skills
• Negotiation skills
• Open enrollment
• Monday
• HIPAA
• Analysis skills
• Record keeping and documentation
• Multitasking
• Attention to detail
• Customer support
• Software troubleshooting
• Medicare PART C and supplemental benefits knowledge
• Clerical experience
• Claims substantiation
• Employee benefits programs
• Wellness program development
• Well-versed in WEX Cloud, including COBRA Point
• Healthcare management
• Compliance and regulations
• Medical terminology
• Microsoft Access
• Outlook
• Benefits administration
• Software troubleshooting
• HIPAA
• Windows
• Analysis skills
• Problem management
• Typing
• Customer service
• Live chat
• Medical records
• Computer literacy
• Medical terminology
• Data entry
• Salesforce
• Organizational skills
• Microsoft Office
• Insurance verification
• Computer skills
• Research
• Outbound calling
• Five 9 (3 years)
• Genesys
• Call center
Contact this candidate