Medical Service Representative

JAYMIELEE CRUZ

**** ******* ** *** *** HOFFMAN ESTATES, IL 60169-1043 773-***-**** 708-***-**** ***.******@*****.*** **************@*****.***

Professional Summary

Graduated Pharmacy Technician. Solid experience in the customer service field with overall knowledge of the control, marketing, supervision, training resources and bilingual. Experience Cosmetologist with direct customer interaction. School of Tomorrow certified teacher.

Skills

●Team liaison

●Self-motivated

●Strong verbal communication

●Conflict resolution

●Extremely organized

●Team leadership

●Data management

●Client assessment and analysis

●Staff development

Very well prepared for customer service. Team learner, team player, excellent communication skills, work efficiently under pressure, fast learner, excellent trainer, fully bilingual (Spanish & English), keyboard knowledge, multitask, very organized, focused on work environment safety. High Biblical and Academic teaching. I have commitment and vision for the work.

Work History

JC Restoration, INC. 03/2018 – 04/2019

3200 Squibb Ave. Rolling Meadows, IL 60008

Receptionist

●Welcome visitors by greeting them, in person or answering by telephone; answering or referring company inquiries. Sorting and distributing mail. Scheduling meetings and travel for executives.

●Direct visitors by maintaining employee and department directories; giving instructions.

●Maintains security by following procedures; monitoring logbook; issuing visitor badges.

●Responsible for handling front office reception and administration duties. First point of contact with guest, contractors, subcontractors, adjusters and customers.

●Effective communication, professionalism, interpersonal aplomb, multitasking capabilities, organizational abilities, technical prowess.

●Opening and closing of the office.

●Placing orders for supplies.

●Creating files.

Cooperativa de Seguros Multiples de Puerto Rico TeleSolutions 11/2012 – 01/2018

Customer Service Representative

●It has accessibility of the 24/7 customer field, and constant publicity of marketing growing products. Receiving calls from customers and resolving all their situations with their policies.

●Working hand in hand with agents and adjusters.

●The view is to provide the best alternative to ensure their commitments based on superb service.

●Having an extraordinary work environment which promotes personal development, family, professional and economic development of department.

●Transcending the mere provision of financial services to promote social and cultural development of our people.

●The mission is to offer special protection to individuals and organizations.

●At this position I give training to new employees as well.

●Some additional work done are actualizing personal and confidential information of the insured, receiving payments, sending email data, payments certifications and making claims.

●Also, I’m trusted on working on English calls.

Target Human Resources Solutions – San Juan, P.R. 06/2011 – 10/2012

A trusted partner for Human Resources professionals not only centralized in Puerto Rico, but all over the world as well. It has developed effective and efficient protocols for recruitment and selection that identify the best potential candidates, evaluates their qualifications, all while delivering a list of capable and experienced candidates from which to choose.

●I served the Human Resources Department by helping them internally by making the candidates profile in the system and calling them for the appointments.

Secure Document Imaging, LLC & POP HEALTH MAN

Scheduler – Call Center

SDI & PopHealthMan it is located in Scottsdale, AZ, USA. They have a call center located in the agency Target Marketing. SDI & PopHealthMan is a diverse network of highly motivated and vastly experienced individuals from throughout the medical, business and technological field. Through their united knowledge we were able to endorse multifaceted solutions that offers protected medial record retrieval, secure medical record transfer, and medical record storage. As a highly dynamic group, we realized early on the significance of supplying clients with the means to obtain a secure image of a medical record and the importance of providing them a cost effective, superior quality solution. SDI & PopHealthMan provides innovative technology available all throughout the United States and Puerto Rico.

I worked through a call center, I was on charge of 4 Imagers and I send them to the medical offices or to the Medical Record are in the Hospitals in Puerto Rico. I had to coordinate appointments to fill an entire yearly project. We provided reliable and secure transmission and storage of medical record.

The services that SDI & PopHealthMan included:

●Medical record retrieval for Medical Advantage Risk Adjustment Audits, HEDIS Audits, and various other Quality Audits.

●Prepare Annual MCS Data Validation Audits for Medicare Advantage Health Plans.

Through SDI & PopHealthMan we accomplish this by:

●Accounting for each and every medical record requested.

●Upholding professional and effective communication with provider offices for the scheduling of medical record recovery.

●Offering cohesive, professional, and valuable communication with clients.

●Deploying friendly, knowledgeable, and presentable staff to offices for medical record retrieval.

●Ensuring the swift delivery of quality reproductions of paper or electronic medical records to the client.

●Providing highly protected storage and archiving of all data.

SDI takes pride in working with the following types of clientele:

●Medicare Advantage Health plans

●Special Needs Health plans

●Medicaid Health plans

●Risk Adjustment Vendors

●HCC Coding Vendors

●Medical Record Recovery Vendors

●Commercial Health plans

Centro de cuido y Preescolar Rayitos De Sol 08/2010 – 05/2011

Preschool Teacher

Fruto De La Vid Christian Academy 08/2009 – 05/2010

4th – 6th Grade Teacher

Medical Card System Insurance, Co. (MCS), San Juan, P.R. 12/2007 – 04/2009

Customer Service Representative

●Worked with the Classicare, Commercial and Unit-Care plans at a local and overseas level.

●In the Finance Area assisted providers in the invoicing system (1500) and via internet according to their own system.

●According to medical specialties verified the customer and provider eligibility, coverage, tariffs and fees. Handled the stop payments, customer returned checks and timely payments. Used the book of CPT as a reference guide. Expedited provider payments for contracted or professional services.

●Verified and gathered information on delinquent accounts for the Billing Department.

●Indicated what services were covered according to the contract and tariff signed with MCS.

DIRECTV, Carolina, P.R. 12/2004 – 08/2006

Customer Service Representative

●Perform customer services duties such as: maintain an effective communication by phone or in person to assist in resolving issues and concessions, and process delinquent accounts.

●Entice customers to maintain their accounts active and avoid cancellations by providing through product orientation and new offers that fit their actual needs.

●Monitor and analyze established customer accounts to help maintain them active. Verify new customer’s credit status.

●Mail the propaganda correspondence.

●Conduct a major role in maintaining the sales goal as well as the marketing area.

●Participate in the training of new employee’s.

Education:

2016 to 2017 Practice at Walgreens, P.R.

2014 to 2017 Dewey University – Pharmacy Technician, Graduated - Magna Cum Laude

2009 School of Tomorrow – Individualized Studies Teacher Certified

2002-2004 Rogie’s School Of Beauty Culture, Santurce, P.R. – Concentration: Cosmetology

2002 Petra Mercado High School, Humacao, P.R. – High School Diploma

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