Health Insurance Customer Service
Resume:
Lisa Ortiz
Chicago IL, 60640
adzyxa@r.postjobfree.com
Dedicated healthcare professional with strong customer service and administrative skills.
Skilled communicator, adaptable to change, able to identify problems and offer resolutions.
Experienced in patient care, home healthcare, personnel management, Health insurance benefits, Member advocacy, billing, and claims processing.
RELEVANT SKILLS
• Effective communication skills involving daily interactions with physician’s office, pharmacy staff, benefits center, and internal departments.
• Knowledge of CCHHS (Cook County Health and Hospital Systems) software programs
• Skilled in operating multi-line phone, Language Line and Telecommunications Digital Devise (TDD)
• Computer Skills: IMAX, Facets, EXP and Cisco, Microsoft Office, Windows 10, Microsoft Edge, Outlook, Electronic Medical Records applications, various software applications supporting medical insurance benefits, claims processing and billing.
PROFESSIONAL EXPERIENCE
BlueCross Blue Shields IL. Chicago, IL 8/21 - current
Health Advocate Concierge
Provide concierge guidance and support, answering questions from members and providers regarding medical, behavioral health, prescription benefits and claims
Assist members through various communication methods with setting up and accessing their online portals, locating benefits and claims status information as well as health partner option
Participate in projects, assist with training and support.
Navigate various healthcare applications to ensure members obtain optimal health benefits by collaborating with clinicians, Physicians' Offices, behavioral health Department, pharmacy, and benefits center.
BlueCross Blue Shields IL. Chicago, IL 9/19 – 8/21
Health Coordinator Govt Program
Conducting research, performing data entry, responding to inquiries from members, assist with the completion of health risk assessments
Assists in coordination and continuity between health providers and the member’s Health plan
Answer member calls regarding quality of care, supporting the clinicians in the Government programs Department with their provider and member activities.
Contact members, clinical staff, community partners and physicians regarding case management
Contact members to inform and educate them on medical management programs
Evolent Health Chicago, IL 01/17 – 9/2019
Member Service Representative
Document member information on file, including member inquiries, complaints grievances and appeals.
Multi-tasking while prioritizing workload and maintaining thoroughness
Read, comprehend, and verbalize processes and procedures of the organization and of health insurance coverage.
Respond to member/provider/agent/broker inquiries via telephone regarding health insurance benefits, eligibility, and claims.
Proficient in Language Line and the Telecommunications Digital Devise (TDD) necessary to serve Members with language interpretation
Analyze problems and provide appropriate resolutions
Adheres to guidelines for Enrollment/Disenrollment and consistently relays accurate information to members regarding their Medical Insurance benefits.
Proficient in the following systems: Facets and Cook County Health Hospital Systems to complete daily job functions.
Establish and maintain team goals while elevating team performance
Lasalle Network/Health Fitness Lake Forest, IL 10/2017 – 12/2017
Open Enrollment Specialist
•Answer and assist members with Health Insurance questions related to benefits, eligibility, and completing benefits enrollment.
•Verify and update member demographics.
•Enter new policy related data in a timely and accurate manner.
•Provide timely, accurate information regarding enrollment and benefits.
•Advocating for members regarding benefits
•Quickly adapt to new work assigned within the department
EDUCATION
•Harry Truman College Dialysis Technician Certification, 2009 Chicago, IL
•Comp TIA A+ Computer Repair- Certificate 2008 Chicago, IL
•Career Training Center of Chicago CNA- Certificate 2008 (CPR for Adults & Infants) Chicago, IL
•Harry Truman College Medical Terminology Course 2016 Completion
Chicago, IL
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