Bilingual Help Desk & Case Support Specialist
Resume:
Ines Tlaiye
Bilingual/Help Desk Representative
Newcastle, CA 95658
****.********@*****.***
Authorized to work in the US for any employer
Work Experience
Case Specialist III VOUCHERS Workers Comp
Gemini, Inc.-Rocklin, CA
April 2019 - January 2026
• Provided exceptional customer support via phone, email, and chat channels
• Managed a high volume of incoming calls and emails in a fast-paced environment
• Maintained a high level of professionalism and empathy while addressing customer concerns
• Documented all interactions with customers accurately and thoroughly in the CRM system
• Maintained a positive and professional attitude when dealing with challenging customers
• In contact with claims adjusters, verifying the ADJ number, DOI's, payments status, via email, fax and by phone.
• In contact with Law offices to obtain the correct injured worker information, provide updates on their referrals.
• Create voucher referrals from Law office, VRTWC's and general public. Bilingual ETS Help Desk Representative
April 2017 to February 2018
CMIPS II Help Desk Representative
• Managing incoming calls, voicemail, and emails.
• Research, identify, and specify solutions to problems.
• Assisted clients and stakeholders to research, analyze and validate issues and inquiries.
• As ETS and CMIPS Help Desk Representative had both a technical and functional role.
• Accuracy in entitling customers and routing to the correct team for service or dispatch is critical to meeting service level agreements.
Bilingual Office Assistant
ALLSTATE ROOFING
October 2015 to April 2016
part -time)
• Data entry
• Scheduling, organizing and planning
• prepare and mail out invoices daily
• organize and track purchase orders
• Assist with processing payments
Bilingual Service Center Representative/Help desk support COVERED CA/EVENTUS SOLUTIONS GROUP, LLC
July 2013 to April 2015
• Assisted with the California Health Benefit Exchange; Aided open enrollment and the annual benefits evaluation process.
• Educated in assisting with billing inquiries.
• Handle over 60 inbound calls on a daily basis, both in English and Spanish, from health plan representatives and consumers.
• Trusted in obtaining all pertinent information when consumer/provider was calling in with an Exempt, Formal, Expedited grievance or appeal.
• Preform the task of preparing accurate and comprehensive estimates of possible insurance plan cost for consumers.
• Contact health plan carrier to verify active eligibility, benefit coverage, assisted in issue resolution on behalf of the consumer.
• Complied with organizational policies and procedures, regulatory requirements and other established criteria and guidelines.
• Tech support for Agents, Brokers and Certified enrollment counselors, reset passwords and guiding them to use the LMS for classes and certifications Bilingual Front desk/Customer Service Representative H & R BLOCK
January 2013 to April 2013
• Profound knowledge of providing exceptional guest services.
• Outstanding communication and interpersonal skills.
• Excellent knowledge of multiline telephone system. Answered multiple phone lines, screened calls and directed them to the appropriate representative.
• Trusted to resolve member inquiries, respond to general questions, and process payments.
• Outstanding organizational skills, responsible for updating personal member information within the computer database.
• Coordinated the scheduling of appointments with tax prepare specialist and members with due consideration of their schedules.
Bilingual Drug and Alcohol Counselor
COMMUNITY RECOVERY RESOURCES
March 2012 to December 2012
• Experience in identifying addictive behaviors of clients and counseling them to overcome their addiction problems.
• Strong ability to screen, train and educate patients.
• Excellent communication skills with the ability to assist both Spanish and English speaking patients.
• Holding one on one and group therapy sessions.
• Creating and monitoring individual treatment plans, promoting healthy lifestyles.
• Carried out administrative duties including; answering phones, taking payments, scheduling appointments, filing and drafting documents.
Bilingual Assistant Manager
NEWCASTLE ROOFING
December 2010 to December 2011
• Working with general manager to improve operations, sales and profitability.
• Responsible for controlling cost and expenses.
• Supervising staff and managing team performance.
• Providing exceptional in office experience for our customers.
• Managing staff training requirements, delegating work.
• Processing customer payments, managing money and deposits. Bilingual Bill Collector Specialist
WACHOVIA/HOMEQ/OCWEN
September 2006 to October 2010
• A highly talented Bill Collector with experience in locating and notifying customers of delinquent accounts by mail or telephone.
• Managing over 100 inbound/outbound calls from both clients/debtors in a bilingual queue.
• Developed and implemented FDCPA and Responsible Lending training.
• Confer with clients/debtors by telephone to determine reasons for overdue payments and to review the terms of the loan, service, or sale contracts and determine appropriate solution to delinquency.
• Perform various administrative functions for assigned accounts such as updating customer financials, telephone numbers, address change, sale information, or any new information the customer may provide.
• Advise clients/debtors of necessary actions and strategies for debt repayment such as; automatically drafting payments monthly from our client/debtors checking account, setting up future dated electronic payments, setting up repayment plans when the customer has met the terms of qualification, pre- approving loan modifications, or sending short sale packages.
• Documenting every account with the information exchanged during the phone conversation.
• Exceptional ability to reduce company and investor losses by providing loan counseling to educate the clients/debtors in smart money management to stop movement to foreclosure and loss.
• Educated in computer programs: Bill view, Word Excel, Outlook, MSP program, IT Turbo, Pentagon, DEALL, MS window.
Bilingual Customer Service Representative
American Health Care
May 2006 to September 2006
• Exceptional customer service for both health plan members and providers.
• Educated in Health Plan Benefits and Pharmacy Benefits.
• Answered incoming calls regarding plan benefits, coordination of care, and claims.
• Documented all call activity in an effort to track member/provider inquiries for future resolution. Bilingual Customer Service Representative
EDS/Maximus
September 1999 to March 2006
Research and Appeals Departments
• In-depth knowledge of the Max2 systems and application processing, answered customer questions on medical eligibility and any assistance in filling out health insurance application.
• Processed correspondence, inquires, complaints, appeals and request for fair hearing in an accurate and timely manner.
• Ability to recognize potential errors being made out of other departments and provide feedback for quality purposes.
• Consistently meet performance benchmarks in all areas (Quality Audits, Work, Hold, and Handle Times). Became the "go-to" person for new reps and particularly challenging calls as one of the mentors/trainers of both new and established employees.
• Help company attain monthly service levels, and customer service ratings (as determined by external auditors) -- earned 98% or higher marks in all categories including communication skills, listening skills, problem resolution and politeness.
• Officially commended for initiative, enthusiasm, tenacity, persuasiveness, intense customer focus and dependability in performance evaluations.
• Hard working and trusted to provide excellent customer service. Handle over 80 inbound calls on a daily basis, both provider and member inquiries, and trusted to provider first time resolution.
• Knowledge of HIPPA Compliancy.
Education
Other
Skills
• Clinical data entry
• Client services
• Proofreading
• Data entry
• Clear language communication
• Microsoft Excel
• Microsoft Outlook
• 45 WPM
• EXCEL
• Attention to detail
• OUTLOOK
• Clerical experience
• Conducting sales calls
• Client interaction via phone calls
• Typing
• Live chat
• WORD
• Computer operation
• Phone communication
• Customer support
• Phone etiquette
• Appointment scheduling
• ACCESS
• Organizational skills
• Google Sheets
• Time management
• Customer issue escalation
• CRM system proficiency
• Filing
• Customer service
Languages
• Bilingual
• English
Additional Information
• Over a year of experience as a medical interpreter for several healthcare facilities
• Knowledge of claim processing in medical insurance
• Knowledge of insurance policies and coverage's, claim payment procedures
• Proficient data entry skills and amazing ability to work autonomously
• Ability to work with numbers and words meticulously
• Familiarity about working in fast moving high paced transaction environment
• Knowledge of medical terminology
• Excellent communication skills with both customers and coworkers
• Proficient user of MS Office (Word, Excel, PowerPoint, Access and Outlook). Type 45 WPM
• Familiar with HIPAA Regulations
• Experience documenting all consumer encounters in a clear and concise CRM (Customer Relationship Management)
• Over two year as Help desk support for Agents, Brokers, and Certified Enrollment Counselors Core Competencies
• Excellent organizational and administrative skills- Detail oriented with high degree of accuracy
• Experienced in handling highly confidential matters with discretion
• Written and verbal communication skills
• Demonstrated expertise in MS PowerPoint, Excel, Word and the Internet
• Team working oriented - Ability to prioritize and work under minimum supervision Technical Proficiencies
• MS Word, Excel, Outlook, MS PowerPoint, Publisher, Access, SharePoint
• Type 45 WPM/ 10 Key average 9800kph
• Multi sessions and use of Dual monitors
• ORACLE
• CS Cloud Service
• Soft phone
• In contact systems
• IPAS (In-Person Administration System)
• NetSuite
• OIM (Identity Self Service)
• OAAM (Oracle Adaptive Access Manager)
• CA Service Manager
• CMIPS II
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