Customer Service Representative

Profile:

A decisive manager with over ** years experience in a corporate sales & marketing environment. Exceptional organizational skills. Powerful leadership and management expertise particularly in the areas of project planning, coordinating, training, and creation of information tracking systems.

Experience:

MedImpact Oct 2021 – Oct. 2022

Customer Service Representative San Diego, CA

Responsible for resolving inquiries from patients, pharmacies, clients, hospitals and provider’s offices related to benefit information, claims adjudication, eligibility verification, appeals, and prior authorizations.

Created quotes for prescriptions based on quantity, strength, day’s supply and coordinated the order and transfer of prescriptions based on their degrees of urgency to mail order, retail, and specialty pharmacies.

Initiated prior authorizations, and investigated coordination of dual benefits, and located other funding sources, such as co-pay tier exceptions, limited income subsidies, and manufacturers’ patient assistance programs on behalf of the patients per the client specifications.

Willis Towers Watson Aug 2019 – April 2020

Pension Specialist San Diego, CA

Investigate and determine status on customer’s requests for initiating activation of pension benefits.

Performed customer service support and met clients’ day-to-day administrative needs with respect to defined benefit pension plans.

Process database changes, create estimates, assist members in obtaining website access, and collect information for initiating transfer of benefit monies for survivors included for beneficiary benefits.

Covance Jan 2019 – Aug 2019

Program Specialist San Diego, CA

Verified insurance and income parameters of patients to complete qualification for medicinal assistance programs.

Selected by management to work on a software project that automated initial and refill orders of medicines for health care providers for a new database platform.

Assigned as team lead for final quality control authorization, as well as research contact for verification of licensure for physicians.

Toro AG May 2018 – Jan 2019

Line Operator San Diego, CA

Validated shipping and receiving documents to complete orders and maintain accurate warehouse inventory levels.

Utilized basic measuring and computer observation equipment to make quality assurance determinations between good product and scrap by interpreting basic test results using visual work instructions and independent judgment.

Adjusted line controls using computer or machinery adjustments to ensure continuity of production.

Walmart Nov. 2015- May 2018

Produce Associate – CAP II San Diego, CA

Zone, cull, and restock fresh produce, refrigerated goods and frozen foods. Prepare stockroom freezers and refrigerators for processing and receiving of daily deliveries. Verify manifests for incoming vendor shipments, seasonal line pallets, and high end merchandise and ammunition.

Resolve discrepancies in orders received, verify product flow for inventory removal due to donations, salvage, regular returns or hazardous material claims.

State of Texas Department of Health & Human Services Jul. 2013- April 2014

Texas Works Advisor El Paso, TX

Obtained, verified, and calculated income and resources to determine client financial eligibility for social service programs. Communicated with internal and external stakeholders to provide and verify information, answer inquiries, address issues, or resolve problems.

Processed, monitored, reviewed, and communicated case status and changes to clients, their families, or authorized representatives. Calculated and processed changes to client benefits such as overpayments, adjustments, or restoration of benefits.

Interviewed clients, family, or authorized representatives to gather information for use in determining benefit eligibility. Certified program eligibility, computed benefit levels, and determined the length of eligibility.

Conducted reviews to determine or verify new and continued program eligibility. Explained program benefits, requirements, rights of appeal, and fair hearings to clients, their families, or authorized representative. Documented case records to maintain accurate and confidential client records.

Family Dollar Aug. 2012-April 2013

Store Manager El Paso, TX

Responsible for coordinating daily operations; processing freight, merchandising sales floor with existing product and weekly shipments, inventory control, tracking and reducing internal and external theft, maintaining employee training levels, and daily store operating programs.

Formulated pricing policies by reviewing merchandising activities, determining areas of additional needed sales promotion by authorizing clearance sales, then studying weekly sales trends.

Determined marketing strategy changes by reviewing operating and financial statements and departmental sales records. Implemented weekly sales programs and coordinated vendor sales campaigns to match corporate advertising requirements.

Dillard's Inc. May 2011-July 2012

Area Sales Manager El Paso, TX

Responsible for managing employees in six departments, training area employees in sales techniques, suggestive selling and computer systems, maintaining inventory controls by comparison of actual calculated sales and available physical inventory, and prepared and completed action plans to maintain and increase merchandise flow.

Improved sales results by contributing information and analysis to functional strategic plans and vendor reviews, evaluating floor space and floor plans to redirect customer flow for changes in seasonal merchandise, and coordinated materials and plans with other managers to develop product and signage positioning.

Progressive Insurance Claims Nov. 2006-Sept. 2009 Inside/Outside Claims Adjuster San Diego, CA

Responsible for determining coverage, deciding liability, informing customers on coverage levels and repair options, coordinating repairs, and writing property damage estimates for the State of California.

Conducted prompt and thorough investigations, evaluated facts, interpreted traffic laws and regulations, and rendered claim liabilities, including compensability and medical determinations.

Assisted policy holders with filing third party claims, representation in small claims court, scene investigations, and tracking claimant owners and vehicles for future subrogation billing.

Promoted to special inside claims unit that handled vehicle losses throughout entire United States.

State Farm Insurance Nov.2004–June 2006

Business Insurance Specialist - Personal Lines Specialist San Diego, CA

Directed and coordinated the activity of office to maximize multi-lining new and existing client base between auto and life insurance specialists.

Successfully developed market niche for new product line for business-to-business insurance, including liability, commercial automobile, worker’s compensation, errors and omissions, and state mandated bond performance.

Handled the daily operations required to run office; customer inquiries, claims originations, quoting new business, processing payments, activity reports, and requested coverage changes.

Education: March 1993

California State Polytechnic University, at Pomona Pomona, CA

Bachelor of Science - Business Administration in Marketing Management

Emphasis: Distribution and Logistics

Skills: Highly proficient in using various office suites and Internet communication packages.

Jeff J. Girardot

4482 LOUISIANA ST #3 SAN DIEGO, CA ● Phone: 619-***-**** ● ********@***.***

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