Customer Service Call Center
Resume:
Claudina Myers
Customer Service expert who identifies customers needs and delivers
exceptional solutions to problems. Provide a valuable contribution to your organization and an opportunity for personal career growth in different fields of jobs.
108 Baker Lane Ne
Albuquerque, NM 87113
***********@**********.***
EXPERIENCE
Western Sky Community Care, Albuquerque, NM — Call Center Representative
September 2018- September 30, 2024
● Centennial Health Plan: Medical, Dental, Vision Benefits
● Verifying eligibility for Medical, Dental, Vision, Transportation
● Research caller issues/problems to find resolutions
● Timely follow up with members, routing callers to correct department
● Volunteered for Health Fairs
● Tribal Liaison assistant/Dine’ Interpreter
● Worked from home 9 months
● Part of a Groundbreaking staff for a new company
● Working with HIPPA/PHI confidentiality
Presbyterian Health Plan, Albuquerque, NM — Health Plan Representative
April 1999 - June 2017
● Accounts Management
● Providing benefits for several different insurance plans, requesting review on claims, submitting appeals and grievances.
● Updating, verification of eligibility, routing calls, conference calls with Provider offices, various offices for members.
● Traveled to attend Health Fairs in New Mexico.
● Assisting members with scheduling medical appointments
● Assisted Tribal Liaisons/Dine’ que
● Worked from home for 7 months
● Billing department, collection calls, entering adjustments, posting payments, cashiering
● Working with HIPPA/PHI confidentiality
● Worked at Kaseman Hospital ER insurance verification EDUCATION
Gallup High School, Gallup, NM — High School Diploma August 1988 - May 1991
Required and Electives
SKILLS
Maintain inbound/outgoing
calls, Ability to use Microsoft
Excel, Outlook and Word.
Multiple lines of calls,
multitasking, bookkeeping,
meeting Adherence, Quality,
Performance, flexible to
changes and updates,
utilizing group chat systems.
Basic knowledge of UB-92
and Explanation of Benefits
(EOB) interpretation. Basic
knowledge of CPT and
ICD-codes. Learns to use
professional concepts; applies
company policies and
procedures to resolve routine
issues. General knowledge of
accounting principles,
pharmacy operations, and
medical claims.
Assisted with logistics and
legal processes to open a
brand new Trucking
Company.
LANGUAGES
English and Dine’ (Navajo)
REFERENCES
Laurita Curley 505-***-****
*************@*******.***
Sandra Mancha 505-***-****
*********@*****.***
Sharee Shurtleff 505-***-****
***********@*****.**
Contact this candidate