Dedicated and knowledgeable individual with vast experience providing exceptional customer service to a wide variety of clients. Proven ability to quickly assess customer needs and provide appropriate solutions. Skilled in resolving customer issues, managing customer relations, and providing detailed product knowledge. Committed to streamlining processes to improve customer service efficiency and satisfaction.

MEMBER SERVICE COORDINATOR — State Of California

, February 2023 - Present

CLAIMS SPECIALIST — State Of California

US, March 2022 - Present

CUSTOMER SERVICE REPRESENTATIVE — Jayco insurance

Woodland Hills, CA, January 2019 - November 2021

Valerie Jimenez

Phone +1-818-***-****

Email adymv2@r.postjobfree.com

Address Winnetka, CA 91306

• Assist members with authorization status

• Assisted providers with authorization status

• Verified eligibility for both members and providers

• As a remote fact-finding agent, duties included:

• Analyzing claim information to determine the cause of outstanding issues Assessing eligibility requirements based on UI Code, Policies and Procedures, Evaluating wage and earnings

(irregular reporting which included backdate issues, late submissions, inaccurate last employers or inaccurate last day worked

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Communicating with claimants and employer's by phone to obtain missing information working closely with subject matter experts to gain further understanding of unique issues and how to address them

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• Referring more complex issues to tenured staff

Notating all contacts and actions taken on claim clearly and thoroughly with attention to detail and accuracy as these were legal documents

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• Demonstrating the ability to make timeline and logical decisions

• Performed Quality Control of cases prepared by the agents by Metrics provided by the State

• Participated in over 150 hours of professional development courses

• Worked with multiple systems including NICE, Virtual Contact System, SCBD/OTECH, CUBS, Microsoft

• Teams, Amazon Workspace, Corner stone learning and Virtual desktops

• Responded to claim inquiries

• Performed data entry for customer information

CAREER OBJECTIVE

EXPERIENCE

INDEPENDENT CONTRACTOR — Healthy Halo

Winnetka, CA, June 2018 - January 2019

AGENT PRODUCTION ASSISTANT — Clear Image

Sylmar, CA, March 2018 - May 2018

SENIOR BENEFITS CONSULTANT — Healthy Halo Services Burbank, CA, January 2016 - January 2017

US — Well Point

Woodland Hills, CA, January 2013 - January 2016

BROKER ASSISTANT — Well Point

Newbury Park, CA, January 2011 - January 2013

CUSTOMER SERVICE — Southwest Administrators Inc

Alhambra, CA, January 2007 - January 2011

DATA ENTRY CLERK — Southwest Administrators Inc

Alhambra, Ca, January 2007 - January 2011

• Answered general questions

• Resolved customer information and complaints

• Assisted production manager with work flow, purchase orders, shipping and receiving

• Assisted customers with open enrollment in to the Obama care exchange as well as the private market

• Received in bound calls as well outbound calls

• Handled calls in a timely manner and maintained a daily call log

• Customer service

• Licensed agent handling open enrollment

• Received inbound calls in regards to the changes in health care reform Assisted with retaining accounts and changing plans suitable for health care reform that would suit the customers' needs medically and financially

•

• Handled calls in a timely manner and also maintained a daily call log

• Customer service

• Received inbound calls, managed a daily call log

• Assisted brokers with new applications, membership and claim status Effectively assess customer needs, answer questions and identify creative solutions to address any concerns or complaints

•

• Provided members and their providers with medical and dental eligibility as well as claim status

• Handled calls in a timely manner

• Customer service

• Explained products and benefits

• Confirmed payments, refunds, etc

CLERK — Gulf Pacific Packaging

Vernon, CA, January 2006 - January 2007

ADMINISTRATIVE ASSISTANT SUPPORT — Smart and Final Granada Hills, CA, January 2004 - January 2006

PAYROLL — Restaurant Depot

Van Nuys, CA, January 2001 - January 2004

HIGH SCHOOL DIPLOMA

— Chatsworth High School

Chatsworth, CA, Jun 1996

• Medical billing and collection CMS

• Ordered supplies and merchandise

• Maintained and organized records

• Communicated and coordinated with others

• Operated and balanced cash register

• Accounts Payable and Receivable

• Supervised cashiers and maintained cash room

• New hire intake

• Full results: Proficient • Communication skills

• Medical terminology • Time management

• English • ICD-10

• Microsoft Excel • Typing

• Accounts Receivable • Insurance Verification

• EMR Systems • Customer service

• Organizational skills • Clerical experience

• Languages • English - Fluent

• Certifications and Licenses • Property and Casualty License

• March 2019 to February 2023 • OI51228

• Assessments • Customer service — Proficient

• December 2021 Identifying and resolving common customer issues

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• Customer focus & orientation — Familiar Responding to customer situations with sensitivity

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• Full results: Familiar • Medical billing — Proficient

• February 2021 Understanding the procedures and forms used for medical billing

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EDUCATION

SKILLS

• Attention to detail — Proficient Identifying differences in materials, following instructions, and detecting details among

distracting

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• Information Indeed Assessments provides skills tests that are not indicative of a license or certification, or

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• Development in any professional field.

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