Service Representative Customer

GABRIEL DE LA VEGA ROMAN

Flamboyan Gardens H** Calle 10 Bayamón, PR/ Phone: 787-***-****/ Email: ***********@*****.***

Dynamic, passionate and proactive professional with exposure to different operational areas including Office Administration, Customer and Provider Services for local and international organizations. Fast learner with superb analytical skills, effective in decision making processes maximizing time and resources, improving processes and generating accurate solutions. Fully bilingual (Spanish and English).

EDUCATIONAL BACKGROUND

Bachelor’s in Health Service Management (2018- Present) Ana G Mendez University, Metro Campus

PROFESIONAL EXPERIENCE:

Credentialing Specialist (2018 to Present) Molina Healthcare Inc, San Juan, PR

Review credentialing files and work with healthcare providers to obtain missing, incomplete and expiring items.

Establish and maintain longer working relationships with healthcare to ensure customer satisfaction retention.

Maintain consistent contact with healthcare providers to ensure that expectations are clear and requirements are completed in a timely manner.

Utilize advanced problem-solving skills to resolve issues and conflicts that may arise.

Performs necessary documentation required by regulatory agencies to comply with the audit process.

Member & Provider Contact Center (2015 to 2018) Molina Healthcare Inc, Caguas, PR

Managed tasks from the assigned business line, fulfilling the established protocol and assuring the highest quality of service.

Analyze, solve and document the situations presented by the customers and/or providers.

Prepare coverage certifications, among others official documents.

Process card duplicates and primary care provider changes

Receive, direct and document complaints from customers and/or providers according to the established protocol.

Customer Service Representative (2014 to 2015) First Medical, San Juan, PR

Provide accurate, valid and complete information by using the right methods/tools.

Keep records of customer interactions, process customer accounts and file documents.

Handle complaints, provide appropriate solutions and alternatives within the time limits and follow up to ensure resolution.

Serves customers by providing product and service information and resolving product and service problems.

Maintains customer records by updating account information.

Customer Service Representative (2013 to 2014) MCS Classicare, San Juan, PR

Managed tasks from the assigned business line, fulfilling the established protocol, assuring the highest quality of service.

Analyze, solve and document the situations presented by the customers and/or providers.

Prepare coverage certifications, among others official documents.

Process card duplicates, PCP changes and premium payments.

Receive, direct and document complaints from customers and/or providers according to the established protocol.

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