Customer Service Representative

Melissa Armendariz

El Paso TX, *****

Professional Summary:

10+ years of experience as Customer Service Representative with various healthcare settings. Recent experience in Customer Service, review veteran claims and process based on eligibility and assisted providers on how to submit clean claims for reimbursement. Skilled in processing and reviewing appeals status on denied claims, submitted notes to further authorization or extension approval.

Performed veteran questionnaire for scheduled diagnostic imaging, created veteran authorizations for chiropractic, gynecology, pediatric and acupuncture care.

Strong knowledge of medical terminology to better understand and can easily take 70-75 calls in a day. Proficient in Microsoft office and has very good communication skills. Skills:

• Data Communications

• Information updates

• Able to work independently and as a team player.

• Knowledge of medical terminology

• Efficient with healthcare claims, billing, or related claims area

• Proficient with outlook, Microsoft excel and internet on-line system. Education:

Riverside High School- El Paso, TX 1993

High school diploma

Professional Experience: Sept 2023-June

Wollberg Michelson/Arkansas Blue Cross Blue Shield 2024

Claims Specialist 1

• Reviewed claim files to ensure accuracy and completeness

• Resolved claims by approving or denying documentation, calculating benefits due, and

• determined compensation settlement.

• Prepared reports by collecting, analyzing, and summarizing information

• Created excel spreadsheets and files for client/patient follow-up. Wisconsin physician services/Tricare- (Remote) Sept 2022 to Aug 2023 Customer Service rep

• Answered consultant with minimal wait times.

• Developed in-depth understanding of insurance policies and procedures.

• To give accurate recommendations to suit client’s needs.

• Maintained strong knowledge of medical terminology to better understand services and procedures.

• Leveraged new systems and training resources to help apply processes and procedures. Triwest healthcare alliance (Remote) Jan 2020 to Aug 2022 Claims representative

• Provide superior customer service and effective communication skills.

• Review veteran claims and process based on eligibility.

• Assisted providers on how to submit clean claims for reimbursement.

• Processed and reviewed appeals status on denied claims.

• Reviewed claims and sent them for reprocessing for proper reimbursement. Triwest Healthcare Alliance – (Remote) Aug 2018 to Jan 2020 Customer Service Rep

• Provided eligibility for both veteran/provider/clients.

• Submitted notes for further authorization or extension approval.

• Performed veteran questionnaire for scheduled diagnostic imaging.

• Created veteran authorizations for chiropractic, gynecology, pediatric and acupuncture care. Holistic Home Health- El Paso, TX Oct 2017 to Aug 2018 Home Health Provider Supervisor

• Provided supervisor client relation assistance for home care necessities.

• Assisted with data entry for time recording purposes.

• Created excel spreadsheets and files for client/patient follow-up.

• Utilized outlook for prompt response as needed from client/supervisor. GC Services- El Paso, TX Oct 2006 to Sep 2013

Call center trainer

• Established positive, ongoing professional relationships with customers and coworkers.

• Supervised and coordinated 20-40 employees.

• Evaluate employee performance to gauge where skills are lacking.

• Quality assurance

• Process documentation and project audits

• Deliver call monitoring and audits.

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