LILIAN C. BERNAL (VARGAS)

*** ****** **, **********, ** 15213

412-***-**** addwqm@r.postjobfree.com

OBJECTIVE

To find a position that utilizes my expertise, leadership, and organizational skills while building interpersonal relationships.

SKILLS & ABILITIES

14 years of successful business ownership, including hiring, training, and managing up to 10 employees. Handling customer care, long term rapport with loyal clientele. Managing all aspects of the finances of the business (payroll, taxes, supply chain management, inventory), and acted as human resources agent.

Five years of experience in the Health Insurance Industry, customer care, and handling of international claims for members.

Trained and handled Comprehensive, HMO, PPO, POS, EPO, Medicare Supplemental Policies, Medicare Advantage Plans, and Medicaid Policies.

Proficient in Microsoft Office (Word, Excel, Power Point, and Outlook), and Highmark’s and UPMC HealthPlan’s Windows and Mainframe Applications.

Professional Fluency in English and Spanish (Native Spanish speaker).

EXPERIENCE

July 2018 to January 2019

January 2004 to April 2018

Bilingual Member Services Concierge, UPMC Health plan

.Communicated effectively via inbound and outbound calls, chat, and email with members and providers, regarding claims, eligibility, enrollment, grievances and appeals for CHC, Medicare Advantage, and Medicare Advantage Dual Members. Handled medical, prescription, dental, and vision parts of the benefits

.Served as an interpreter for other departments within UPMC Health plan including Federal Market Place Department.

.Successfully completed Ageless Wisdom and Sensitivity training.

.Completed training for Medicare, and Medicaid guidelines and procedures.

Owner and General Manager, Cuzamil Mexican Restaurants

·Managed all aspects of the restaurant/bar, including staff and customers, vendor relations, organized and budgeted special events such charitable causes, and festive occasions. Marketing and social media advertisement campaigns.

·Acted as Human Resources manager, from resume and application selection, to interviewing and hiring.

·Organized charitable events, parties, caterings, and other special events.

June 2001 to October 2005

Bilingual Member Services Representative, Highmark

·Communicated effectively via inbound and outbound member and provider calls, regarding benefits, claims, and medical review procedures.

·Translated and coded international claims, and reviewed claims for approval. Claims adjustments as needed.

·Provided expert bilingual coverage to other Dedicated Units when needed.

·Participated in numerous training classes to increase knowledge of the Health Insurance Industry through Highmark University.

EDUCATION

April 1998 -To- December 1998

Biology/Chemistry (Pre-Medicine), Cajamarca-Perú, Universidad Nacional de Cajamarca

COMMUNICATION

Utilized excellent communication and language skills by serving as a spokesperson for various social service organizations and causes, including hosting fundraisers for disaster relief.

LEADERSHIP

Recognized as an outstanding immigrant entrepreneur by the City of Pittsburgh Mayor’s office, and featured on video for Visit Pittsburgh, promoting diversity within our community.

Spokesperson for U.S. Conference of Mayors’ Day of Immigration Action March 2017.

References provided upon request.

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