Service Representative Customer
Resume:
Robert Gonzalez
********@***.***
Professional Experience:
State of Illinois Dept of Health; Laboratories Division : Environmental Lab June 2024 to present
22nd Century Technologies Inc, Staffing
Environmental Science Tech (contract)
Performing water teting procedures for presence of total coliforms in samples supplied by local facilities.
Adherence to the Scientific method using aseptic techniques with laboratory tools and qualified procedures using Abott labs software for reporting purposes.
Aetna Health Ins. / SGS Contracting January to May 2024
DSNP Member Advocate (contract)
Conducted inbound and outbound calls to Medicare/Medicaid Plan members who would benefit from designated services including nurse home visits and screenings using Dynamo software.
Acted as advocate for dual-plan members needs coordinating care between plan provisions and Aetna provider plan network.
To assist members in order to provide solutions, facilitate positive health outcomes by closing gaps in essential care and support services using CMS Dynamo software. Also to improve member experience and member retention
BlueCross Blue Shield of Arkansas / Hornet Staffing April to Sept 2023
Provider Preauthorization Intake Specialist (Contract)
Handling incoming calls from Providers for the purpose of creating applications for preauthorization requests.
Also cancelled and initiated changes to preauthorizations using Diagnosis and CPT codes per request.
Bright Health Ins., Mo / Oct 2021 to Jan 2023
Bilingual (Spanish) Membership and Enrollment Specialist (contract to hire)
Handling incoming calls from members for the purpose of effectuation, cancellation, and reinstatement.
Performing refund requests for active, and ex-members due to overpayments and cancellations.
Performing payment processing as well as well as the set-up and disabling of automatic payments.
Performing ticket/case escalations for member account inconsistencies, as well as coverage and billing issues.
LINCARE LLC, Chicago, IL / Integrated Resources Apr 2021 to Sep 2021
Customer Service Representative (contract)
Handled orders for oxygen tanks, concentrator supplies and scheduled maintenance for all oxygen devices for all oxygen patients.
Set up discharge tanks for patients being discharged from Chicago area hospitals.
Transferred services for patients moving to other states to be serviced by corresponding office.
Insight Global Staffing /Go-Health Inc., Chicago, IL Sep 2020 to Jan 2021
Health Plan Advisor/Licensed agent-producer (contract)
Health Plan Advisor/Licensed agent-producer
Enrolled new members into FFM qualified Network health and dental plans with and without regard to advanced income tax credit and cost sharing, as it applies Bronze/Silver level health plans while adhering to all HIPPA Standards
Achieved the highest level of sales, for the month of December 2020, among 8 team members.
Advanced Resources /HUB International Apr 2018 to Aug 2020
Customer Service Representative
Performed Turborater quotes for over 20 different major insurance carriers.
Performed auto, home, flood and umbrella policy cancelations using Epic software.
Performed endorsements for additional auto(s), driver(s), and coverages according to client’s needs.
Initiated the resolution of all types of billing/Check issues.
Informis (formerly Vangent) Health Solutions Inc., Chicago, IL Aug 2017 to Dec 2017
Bilingual (Spanish) Plan Enrollment Representative
Set up licensed agent appointments with prospective members for the purpose of enrollment into Scan Medicare advantage health plans.
Set up seminar reservations for prospective members for the purpose of enrollment into Scan Medicare advantage health plans.
Fulfill requests for Medicare advantage health plan literature to be mailed to prospective clients.
Manage all inquiries regarding Scan Health Plan benefits, as well as coverage details including copays, and coinsurance.
Achieved the highest number of in-home agent appointments for the months of September and October.
Beacon-Hill Staffing /Access Community Health System, Chicago, IL Feb 2017 to Jul 2017
Bilingual (Spanish) Field Research Data Specialist (contract)
Interviewed and enrolled Diabetic patients into the “Food for health” clinical study for the purpose of improving “food insecure” patient outcomes using Epic medical software for scheduling new participants.
Secured and scanned all HIPPA compliant authorization/consent documents to allow patient participation and researcher access to lab results for the duration of the study (August 2018).
Achieved the highest level of appointments for the first three months out of six.
Go-Health Inc., Chicago, IL Sep 2015 to Jan 2017
Licensed Health Plan Advisor - Agent/Producer
Enrolled new members into FFM qualified BCBS Network health and dental plans with and without regard to advanced income tax credit and cost sharing, as it applies Bronze/Silver level health plans while adhering to all HIPPA Standards
Achieved the highest level of sales, for the month of January 2017, among 18 team members.
Valence Health Inc., Addison Group Staffing, Chicago, IL Mar 2015 to Aug 2015
Member/Provider Services Representative (contract)
Answered 40 to 50 calls from members and providers regarding “Land of Lincoln” Healthcare policies benefits, coverage, and claims, while strictly adhering to HIPPA privacy policy for patient health information.
Preformed provider and member assistance with portal registration, as well as password resets as needed.
Initiated claims reviews when claims were processed “out of network” in error.
Provided preauthorization/precertification approval information on behalf of providers and members.
Initiated check trace requests on behalf of providers in regards to their claims payments.
Go-Health Inc., Lasalle Network Staffing, Chicago, IL Sep 2014 to Feb 2015
Licensed Health Plan Advisor - Agent/Producer
Presented FFM qualified Blue Cross/Blue Shield healthcare, and dental plans to prospective clients seeking to enroll, or change health care plans according to their particular health care needs.
Enrolled new members into FFM qualified BCBS Network health and dental plans with and without regard to advanced income tax credit and cost sharing, as it applies Bronze/Silver level health plans.
Education:
Morton College, Cicero, IL, 2004
Associate in Liberal Studies Degree (ALS)
Phi Theta Kappa Honors Society / Deans list
Certifications and Licenses:
Licenses and associated certifications optained:
Agent/Producer - Healthcare license 2014
Agent/Producer- Life license 2016
Agent /producer- Property and Casualty
NET Certification 2019
Microsoft Office Certification (DMO)
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