Customer Service Los Angeles

Los Angeles, CA *****

626-***-**** ***********@*****.***

Dependable and detail-oriented to manage multiple tasks and priorities. Articulate communicator with strong attention to detail and superior work ethic. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Hardworking employee with customer service, multitasking and time management abilities. Devoted to giving every customer a positive and memorable experience. Motivational Leadership

Microsoft Office Suite

Time Management

Decision Making

Customer Service

Team Building

Complex Problem Solving

Microsoft Office

Honesty and Integrity

Verbal and Written

Communication

Multitasking and Prioritization

Spanish Fluency

02/2021 - 03/2023 Network Medical Management Alhambra, CA Compliance Claims Coordinator

Delegated work to staff, setting priorities and goals. Coordinated with other supervisors, combining group efforts to achieve goals.

Discussed job performance problems with employees, identifying causes and issues to find solutions.

Implemented departmental policies and standards in conjunction with management to streamline internal processes.

Participated in subordinates' tasks to facilitate productivity or help overcome difficulties.

Ensure submissions of Independent Physicians Association(IPA) and health plan filings.

Oversee incoming emails from state regulators and healthcare partners. Update Corrective Action Plans from each plan partner and provide them with resolutions.

10/2018 - 12/2020 Blue Shield of CA Monterey, CA Compliance Analyst

Reviewed company policies against best practices to better understand level of compliance.

Created plans to improve and correct operations in order to stay compliant.

Performed special reviews to support management needs. Marcela Garnica

Summary

Skills

Experience

Provided detailed, understandable risk and compliance concepts to key stakeholders.

Completed in-depth reviews of audit reports, client actions and monitoring activities.

Review member facing materials that require a regulation submission. Minute note taker for quarterly Corporate Compliance Committee meetings, Internal departmental audits, and regulatory insight audits. Provide Department of Health Care Services (DHCS) with provider claim data

08/2015 - 10/2018 Blue Shield of CA Monterey Park, CA Privacy Investigator

Completed comprehensive phone interviews with members' and/or employees' to generate reports to document investigative findings. Worked to ensure the confidentiality and privacy of clients. Maintained detailed case log of all cases assigned to monitor progress and completion.

Interviewed subjects, targets and witnesses for information verification and corroboration.

Maintained organized records of all information and material pertinent to open investigations.

Developed case plans and conducted comprehensive investigation tactics to obtain necessary evidence.

Mitigated risk, accurately analyzing and evaluating potential cases. Provide regulators with a Privacy Incident Report of breaches when members' were impacted.

10/2005 - 08/2015 Care1st Health Plan Alhambra, CA Customer Service Representative

Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.

Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions. Remained calm and professional in stressful circumstances and effectively diffused tense situations.

Answered inbound calls, chats and emails to facilitate customer service. Demonstrated excellent communication skills in resolving product and consumer complaints.

Developed strong customer relationships to encourage repeat business. De-escalated problematic customer concerns, maintaining calm, friendly demeanor.

Consulted with customers to resolve service and billing issues. Asked probing questions to determine service needs and accurately input information into electronic systems.

Used proven techniques to de-escalate angry customers during telephone interactions.

Responsible for assisting with new hiring training and prepare for any special projects.

06/1996 Mountain View High School El Monte, CA

High School Diploma

Rio Hondo College Whittier, CA

Some College (No Degree)

Spanish:

Native/ Bilingual

Education and Training

Languages

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