Customer Service Representative
Resume:
SANDY FIGUEROA
INSURANCE SPECIALIST ARLINGTON, TEXAS, UNITED STATES 1-817-***-****
DETAILS
Arlington, Texas
United States
*****-********@*********.***
SKILLS
Microsoft Office
Multitasking Skills
Leadership and Teamwork
Time Management Skills
Customer Service Skills
Effective Time Management
PROFILE
Dedicated Customer Service Representative focused on completing work quickly to consistently exceed targets. Reliable team member on Inbound & Outbound calls totaling 200 a day. Skilled team player with strong background on inbound or outbound environments. Works well independently to handle assignments and always ready to go beyond basics assignments. Quick learner with great computer abilities. EMPLOYMENT HISTORY
Customer Service Agent at Mindlance / Centene Corp., Dallas April 2023 — June 2023
Provided assistance for members and non-members for social service needs. High volume inbound call center.
Developed and implemented process improvements that streamlined customer service operations and improved customer experience. Advanced experience in taking 200 calls daily inbound / outbound calls ranging from 75 to 100 calls daily. Salesforce & Microsoft proficient.
Grievance Coordinator at Spectraforce / Cigna Health Care, Raleigh September 2022 — December 2022
Assisted Members with ID cards through company software. Prescription questions regarding tier explanation, cost share or drug formulary questions. Billing explanation with regards to payments and posting on the account Explained coverage, OOPM
& deductible accumulations. Educated members on their Cost share explanation for medical services for the Market Place.
Member Service Representative at Insight Global / Evolent Health Care, Dallas November 2021 — April 2022
Assisted members with policy information Affordable Care Act. Communicated all prescription questions regarding tier explanation, cost share or drug formulary rules for that state. Billing explanation with regards to payments and posting on the account. Explained coverage regarding OOPM & deductible accumulations. Handled escalated callers to reach positive outcomes. Presented existing and prospective customers with valuable information online for customer to research deciding plan coverage. Remained calm, composed and polite to deescalate aggressive customer behavior. Advanced experience in taking 200 calls daily inbound / outbound call ranging from 75 to 100 calls daily. Salesforce & Microsoft proficient.
Provider Services Associate at Insight Global / Molina Health Care, Dallas October 2020 — October 2021
Experienced with Market Place, Medicaid, Medicare & MMP Dual Plans Verified Member is active or inactive with no restrictions with the account. Explained to providers accumulations of OOPM & Deductible for the Member. Verified information & details on SF Jun 2006 approved Prior Authorizations using CRM & Salesforce. Assisted Providers in obtaining proper forms for services, such as Prior Authorizations, proof of eligibility. Verified CPT Codes, and description that are covered according to that state. Member & Provider Services Associate at Insight Global / Molina Health Care, Dallas October 2019 — July 2020
Assisted Members & Providers with Claims explanation. Prescription questions regarding tier explanation, cost share or drug formulary questions. Billing explanation with regards to payments. Served friendly first point of contact for Member inquiries. Remained calm, composed and polite to deescalate aggressive. Member or Provider behavior. Investigated Market Place Plan concerns and communicated with departments to understand Member or Provider issues.
Customer Service Representative at Pacific Dental Services, Irving December 2018 — May 2019
Scheduled patients for routine or emergency dental issues. Updated daily patient charts
& interacted with our nationwide offices by email or telephone for patient needs. Answered inbound calls to greet and assist customers with various needs and questions. Resolved customer inquiries, complaints and issues providing insightful solutions. Returned customer calls and responded to inquiries and complaints. De-escalated customer complaints using specialized communication techniques. Provided solutions, recommendations and replacements with empathy and positive feedback. Claims Processor at Lynx Services / State Farm, Irving July 2018 — November 2018
Acknowledged inbound customer issues and resolved their problems quickly and efficiently. Processed State Farm glass claims for policy holders verified according to deductible. Verified and reviewed data on insurance applications and policies such as age, name, principal sum and address. Organized the insurance claims forms and related documents, checking each closely for completeness. Followed internal standards and examining guidelines to prevent claims processing errors. Customer Service / Production Assistant at Dealertrack / Cox Automotive, Dallas October 2012 — May 2018
Contacted customers daily in the call center environment with any satisfaction or dissatisfied issues. Documented all calls in depth for service & purchased vehicles for our contracted dealerships. This role required knowledge of description on vehicles description of makes and models. Effectively communicated with team members, and upper management to ensure complete care of our dealerships. Arranged logistics daily for the dealerships. Prepared all dealerships received all proofed correspondence, and reports for sales & service departments in a fast-paced environment. Communicated with our dealerships for any changes on staff updates for accuracy for printing purposes. Problem-solved to turn frustrated clients into repeat customers and improve company bottom line.
EDUCATION
Venture High School, Arlington
September 2005 — June 2006
Graduated - GED
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