Customer Care Representative

Jomar Barretto Abad Santos

**** ******* ******, ***** *** Vegas, NV 89031 Mobile Phone: 310-***-****

Email: ***************@*****.***

OBJECTIVE

Seeking an opportunity with a stable organization where education and experiences can be fully utilized.

EDUCATION

University of Maryland University College

European Division, Heidelberg, Germany

Bachelor of Science in Psychology

Minor: Business Management, June 2000

SKILLS

•17 years combined experience in the field of Psychology, Social Services, and Human Relations.

•Good interviewing technique with excellent analytical skills.

•Excellent track record in successfully interfacing with clients.

•Proven experience interfacing and using collaborative approach to achieve result.

•Strong time management and crisis management experience; able to work under pressure, manage multiple projects, and adjust priorities as needed.

•Knowledgeable in Medicaid/Medicare/ACA policies/practices

•Work closely with Various Rehabilitation hospitals such has Horizon and North Las Vegas

•Proficient in Microsoft Word, Excel, Outlook, Citrix, Macess.

•Experience in utilizing a forklift (was prior certified).

EXPERIENCE

Elevance Health/ FEP Blue Cross/ Blue Shield Las Vegas, NV

12/18/2023- Current Melissa Cummings

Customer Care Representative 22.84/hourly

Answering Inquiries: Addressing customer questions about FEP benefits, policies, and procedures.

Issue Resolution: Solving problems related to claims, eligibility, and other healthcare-related matters.

Providing Information: Explaining healthcare coverage, finding doctors, and assisting with other member and provider needs.

Communication: Communicating with customers through various channels (phone, email, online chat).

Documentation: Keeping detailed records of interactions and resolutions.

Following Procedures: Adhering to established protocols and guidelines for handling customer inquiries.

Collaboration: Partnering with internal teams to ensure a positive customer experience.

Product Knowledge: Understanding the details of FEP healthcare plans and benefits.

Sales Objectives: Some roles may also include meeting sales targets related to FEP enrollment or benefits.

Customer Relationship Management: Building and maintaining strong relationships with customer

Optum/ United Healthcare

Las Vegas, NV

12/20/2021- 09/20/2023

Kenny King

Associate Patient Coordinator

17.82/hourly

•Greets patient, family member and guests with a friendly smile

•Assist patients with signing in and completing registration

•Enters and scans patient’s demographic and insurance information

•Verifies insurance eligibility and benefit information

•Conducts pre-screening of patients

•Collects co-payments and patient balances

•Answers incoming phone calls in a courteous and prompt manner

•Assists physician and clinical staff by coordinating follow- up care for patients

•Sends patient records to primary care physician

•Assist with other tasks as assigned

Seafood City Las Vegas, NV

10/15/20- 7/4/21

Produce Merchandiser 12.00/hourly

•Followed proper standards for product freshness, food safety, weights and measures, refrigeration and sanitation.

•Unloaded trailers, received merchandise, verified orders and broke down produce loads.

•Trimmed, rotated, culled, crisped and watered produce to maintain freshness and attractiveness.

•Addressed guest concerns and resolved all issues to guests’ satisfaction.

United Healthcare Las Vegas, NV

10/8/18-8/16/2019 Jeremy Strong

Group Services, Associate Billing Representative 15.00/ hourly

•Interact with customers through telephone, email, in person contact gathering support data to ensure invoice and enrollment accuracy

•Research and resolve enrollment, eligibility and billing discrepancies on premium invoices

•Educate customers on payment options, billing information, payment addresses, invoice due dates and clarify information contained on premium invoices and electronic services

•Reconcile discrepancies identified within customer invoices or eligibility files and ensure timely resolution

•Analyze reports against existing billing data and billing/commission data to make appropriate changes to ensure billing and statement accuracy

•Monitor customer account balances through researching, generating data queries and creating reports such as member audits and bills issued vs. bills paid reports

•Contact external customers regarding outstanding balances and / or unresolved discrepancies; arrange payments or resolution to reduce aging

•Coordinate with internal partners to validate and process rates and contract information to ensure they are updated accurately

•Utilize multiple reports to research, resolve, and ensure the accuracy of enrollment eligibility

•Accounts payable (A / P) and Accounts Receivable (A /R)

Human Behavior Institute Las Vegas, NV

3/19/18-09/2018 Myisha Gray

Psycho Social Rehabilitation Worker 20.00/ hourly

•Provide strategies in designing planned interventions for challenging clients; assist clients in school, work skills, or with other issues related to their emotional disturbance by obtaining skills to live independently or by preventing movement to a more restrictive situation.

•Provide service for the progressive reduction of the effects of a Mental Health disability; conduct initial on- site assessment, evaluation, and feedback sessions to identify client symptoms or behaviors in accordance with healthcare insurance policies.

•Provide client interventions in mental health training to improve communication skills and facilitate appropriate interpersonal behavior.

•Assist in development of behavior intervention plans; participate in scheduled group meetings to discuss client progress and provide updates for healthcare insurance.

•Facilitate groups in social settings.

RoadSafe Traffic Systems Las Vegas, NV

7/19/17-1/28/18 Patrick Riley

Warehouse Shop Support 12.00/ hourly

•Lifts, carries, loads and unloads various construction items including line painting supplies, signs, tools, steel, aluminum, wood and hardware, etc.

•Prepares, cleans and sweeps work areas and maintain a neat, orderly, work environment.

•Pull orders for devices to be delivered to construction projects.

•Make sure trucks are loaded with proper equipment for set tasks.

•Loads and unload trucks manually and with forklifts.

•Organizing warehouse and shelves

•Assist with product inventory

•Proper use of power tools to cut, drill, and perform various shop related tasks.

•Ensure all safety rules and procedures are always adhered to.

•Perform other work- related duties as assigned.

•Experience in utilizing a forklift (was prior certified).

Pinnacle Community Services Las Vegas, NV

6/14/16-8/23/16 Kelli Slaughter

Program Manager 41,000/yearly

•Supervise in home staff (Lead and Support staff); set staff schedules; assigned duties; coordinate training for staff to ensure their certifications are current; conduct staff meetings.

•Oversee resident funds, schedules and weekly appointments

•Ensure maintenance of the home is completed in accordance with the schedule

•Maintain contact with residents’ families

•Responsible for the management of residents’ medications (e.g. maintain supply, supervise passing of medications, and documentation)

•Participate in required training

•Maintain required records; on call 24 hours a day, 7 days a week; performed duties as directed/required.

Clinical Solutions, LLC Las Vegas, NV 1/2008-8/2011 & 12/2014-2/2015 Dr. Jamil Ali Psycho Social Rehabilitation Specialist (Contract) Salary: 22.50/hourly

•Provide strategies in designing planned interventions for challenging clients; assist clients in school, work skills, or with other issues related to their emotional disturbance by obtaining skills to live independently or by preventing movement to a more restrictive situation.

•Provide service for the progressive reduction of the effects of a Mental Health disability; conduct on site assessment, evaluation, and feedback sessions to identify client symptoms or behaviors in accordance to Medicaid policies.

•Provide client interventions in mental health training to improve communication skills and facilitate appropriate interpersonal behavior.

•Assist in development of behavior intervention plans; participate in scheduled group meetings to discuss client progress and provide updates for Medicaid to obtain.

Legacy Health & Wellness Las Vegas, NV 10/2012 – 12/2014 Rande Paige

Psycho Social Rehabilitation Worker/Basic Skills Technician Salary: 20.00/hourly

•Assist clients & patients in gaining and utilizing skills necessary to participate successfully in treatment such as behavior control, social skills, academic improvement, communication skills, appropriate interpersonal behavior, symptom management, and coping skills

•Provide strategies in designing planned interventions for challenging clients & patients

•Provide service for the progressive reduction of the effects of a Mental Health disability

•Provide interventions and service to promote the highest possible level of success – behavioral, academic – through restoration and maintenance

•Assist in assuring that client/patient assessments are completed in accordance with Medicaid/Medicare policies

•Provide proof of mental health services to Medicaid to obtain more, or reduce assistance for clients/patients

•Conduct quarterly audits to assure all forms are completed in adhering to Medicaid/Medicare guidelines

Compass Behavioral Health Las Vegas, NV

9/2011 – 6/2012 Diane Wade Multiple Roles (see below) Day Treatment Staff Psycho Social Rehabilitation Technician Behavioral Health Technician

Salary: 19.00/hourly Lead

•Participates with program activities to assure client behavioral, emotional, and mental health needs.

•Provides crisis intervention, therapeutic de-escalation, and makes decisions regarding disciplinary actions in accordance with Medicaid policies/practices.

•Conduct initial meetings with potential clients to obtain eligibility for Medicaid insurance

•Provide client interventions in mental health training to improve needed skills and facilitate appropriate interpersonal behavior.

•Assist in development of behavior intervention plans; participate in scheduled group meetings to discuss client progress.

•Maintain a clinical caseload, including assessment and intervention, within agency guidelines.

•Document provision of services, assessments, evaluations consistent with clinical, administrative, and Medicaid policies/ procedures.

North Long Beach Intensive Services Long Beach, CA 11/2001 – 12/2007 Dr. Lyn Walker Senior Mental Health Case Manager Salary: 40,000/ year

•Reviewed case logs; investigated case situations; provided information and advice about specific options and programs; work with other counselors in coordination interviews and confirming case status.

•Conducted regular interviews for repeated case management that needed assessments in the home with parents, guardians, and at schools.

•Assisted families in obtaining community services including medical, optical, dental, educational and financial resources.

•Reviewed financial records of clients to determine their eligibility for program assistance.

•Assisted program directors and psychologists in implementing treatment plans, in creating behavior charts, and in creating schedules for each family and provided parenting skill training; advocated for families with the community and with various agencies as necessary.

•Proposed and submitted proper referrals to other agencies and /or organizations depending upon the needs of the client.

•Interacted and established coordination of services with community at large as well as with allied agencies, other programs, and funding sources in a manner that facilitated and enhanced the operation of the program.

•When needed, implemented billing for agency to assure QMHP procedures were adhered to code regulation.

•Created, monitored, and managed case files for each client; updated individual client records associated with the action plans, outcome measures, and progress report; conducted a continuing study of all clinical policies, programs, and practices.

•Adhered to State and Federal statutes and regulations regarding confidentiality of client records and information.

REFERENCES Available upon request

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