Bilingua Customer Service Representative

TERESA SEVILLA

Covina, CA ***** 213-***-**** ******.*******@*****.***

Professional Summary

Professional with strong background in providing exceptional service and support in customer- focused environment. Expertise in resolving inquiries, managing accounts, and fostering relationships. Known for collaborative spirit and adaptability, consistently driving team success and positive outcomes. Skilled in communication, problem-solving, and multi-tasking in fast-paced settings. Skills

• Call center experience 30 Years • Escalation handling

• Client education • Claims customer service

• Provider appointment scheduling • Knowledge of Authorization referral process

• Insurance verification • Knowledge of Medical/Medicare/PACE

• Microsoft office, teams, and dual monitors. • Computer skills

• Data entry • Administrative and office support

• Spanish fluency • Interpreter

Work History

Member Service Representative 04/2024 to Current

Blue Shield of California – Long Beach, CA

Handled sensitive patient information with confidentiality, adhering to HIPAA regulations at all times.

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Serve as the first point of contact for our members and healthcare providers, assisting with inquiries and providing information about member eligibility and benefits.

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Answer and manage inbound inquiries regrading health plan benefits, claims, eligibility, medical procedures, billing, payments and other related topics from members ina prompt, courteous manner.

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• Accurately document member interactions and transactions using the company's CRM system. File grievances. Adhere to all applicable department, organization, and regulatory policies and procedures

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Referred and screened patients to make best use of resources, triage staff, and serve community members.

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Senior Insurance Representative 03/2022 to 01/2024 Automobile Club of Southern California – Los Angeles, CA Increased client satisfaction ratings by consistently providing personalized and timely assistance with policy inquiries and claims processing.

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Provided exceptional customer service during challenging situations involving claims disputes or policy cancellations.

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Cultivated relationships with clients to identify and meet insurance needs and establish trust and rapport.

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Provided comprehensive product knowledge and guidance to help clients on product selection.

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Recommended type and amount of coverage based on analysis of customers' circumstances using persuasive sales techniques.

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• Educated clients on insurance policies and procedures.

• Monitored customer feedback and identified areas of improvement. Bilingual Case Manager Estate Service 02/2005 to 06/2021 Bank of America – Remote

Resolved customer service issues using company processes and policies and provided updates to customers.

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Demonstrated excellent multitasking abilities by managing multiple concurrent tasks while ensuring timely completion.

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Enhanced customer satisfaction by promptly addressing and resolving complex inquiries and complaints.

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Trained and directed new employees in call script use, conflict resolution, and data entry practices to boost customer satisfaction ratings.

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Addressed escalated issues with diplomacy and tact while finding resolutions that satisfied both the client''s concerns and company interests.

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• Met customer call guidelines for service levels, handle time and productivity. Education

Certificate: CPR CERTIFICATION 08/2024

CPR AND MORE

Certificate: Telehealth 02/2025

University of Delaware/FuturoHealth.org - Los Angeles, CA. Certificate : Health Customer Service Paraprofessional 12/2024 FuturoHealth.ORG - Los Angeles, CA

High School Diploma: General Studies 05/2024

Thomas Jefferson High School - Los Angeles, CA

Certificate: Medical Terminology 05/2024

Hacienda La Puente Adult School - La Puente, CA

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