Customer Service Data Entry
Resume:
Christine Murillo **** Western Sun Drive
Saint Cloud, FL 34771
Christine.murillo3@gmail.
com
EXPERIENCE
PrudentRx- Claims Specialist
JANUARY 2023 - PRESENT
- Responsible for optimizing, identifying, and investigating claims.
-Partnered with providers and members to respond to and resolve inquiries and appeals in a timely and professional manner.
-Detailed-oriented while possessing strong problem-solving skills while utilizing my experience with pharmacy claims processing.
-Review and analyze claims to identify claims that may have been improperly billed to the COB plan for further investigation.
-Ensures data is accurate and updated for efficient claims processing.
-Monitor claims to ensure co-pay cards are utilized and billed properly
-Research, identify, and communicate errors.
-Verify co-pay card fund availability
-Maintain current knowledge of various types of COB and third-party payer rules.
-Meet all regulatory, contractual, or other requirements. United Healthcare - Bilingual Healthcare Customer Service Representative
JULY 2021 - MAY 2022
- Assisting customers in navigating the healthcare system (English and Spanish).
- Assisting Dual Complete Special Needs members (Medicare and Medicaid).
- Answering questions customers have in regards to benefit information, pharmaceutical and/or medical claims, and locating providers.
- Scheduling appointments.
- Submitting appeals and/or prior authorizations for customers in need of having an exhausted benefit, prescription, or non-covered service approved.
- Documenting grievances to help improve overall experience for our customers.
- Emailing appropriate departments.
City Furniture- Bilingual Sales Associate
NOVEMBER 2020 - JUNE 2021
- Staying informed on the latest furniture brands/mattress brands and sales to effectively sell to customers.
- Following-up on prospects.
- Forwarding emails to the appropriate department.
- Selling and prospecting in English and Spanish.
- Escalating complaints and submitting claims on damages. SKILLS
Strong interpersonal skills.
Customer service.
Data entry.
Organized and consistent.
Detail-oriented.
MS Office, Excel, and Word.
AWARDS
•Most sales in June 2018.
•Third in the state of Fl for
most mattress sales (March
2021).
LANGUAGES
English and Spanish
Master Link Group, Miami — Customer Service
Representative
FEBRUARY 2017 - JULY 2019
- Promoted in two months into position of Lead Agent and worked for two years.
- Excellent Customer Service.
- Data entry and emails in English and Spanish, as well as using MS Excel.
- CRM database to manage accounts.
- Processing customer sales domestically and internationally.
- Effectively handling customer complaints.
- Managed emails and performance of 20+ agents
Sunglass Hut, Cutler Bay— Seasonal Retail Sales Associate NOVEMBER 2015 - DECEMBER 2015
- CRM to process sales.
- Up to date with new items.
- Handled exchanges, returns, complaints, and sales of customers.
- Cleaned and restocked display cases.
King Jesus Ministry, Miami — Volunteer
JUNE 2016 - JUNE 2017
- Data Entry in English and Spanish using MS Excel. EDUCATION
Miami Dade College, Homestead — Associate in Science- Nursing
MARCH 2019 -PRESENT
Miramar High School, Miramar
AUGUST 2009 - JUNE 2013
I.B. Program and AP
REFERENCES
Available upon request.
Contact this candidate