Customer Service Professional with Escalation Expertise
Resume:
Tulare, California
Phoenix, US
Phoenix, US
SONIA LOPEZ
Summary
Proactive and versatile professional with a dedication to quickly adapting to new challenges. Strong problem-solving abilities and a proven track record of fostering strong relationships with clients and team members. Focused on supporting team success and achieving positive results. Skills
Experience
Customer Service Representative
Prime Therapeutics LLC
Customer Service Representative
Robert Half
CSR 1
Maximus
Vendor Specialist
Tulare, CA 93274 +1-602-***-**** ***************@*****.***
• Analytical and critical thinking
• CRM software
• Microsoft office
• First-call resolution
• Customer communication and empathy
• Ticketing systems
• Collaborative team player
• Multitasking and organization
• Adaptability and flexibility
• Call center experience
Handle phone, email, and fax communications related to the concierge program, including inbound and outbound functions, to members, pharmacies, prescribers, or plans
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Act as a point of escalation for inquiries that cannot be resolved by Client Concierge Specialists, and handle and resolve escalated inquiries or issues
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Analyzed and troubleshot complex cases by researching and documenting relevant information in claims processing and case management systems within established timelines
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• Set up, tracked, and monitored daily workflow to align with client needs and priorities
• Managed work queues and volumes to ensure adherence to client-specific turnaround times Process Pharmacy Concierge case management cases, including entering, reviewing, and documenting requests in both the claims processing system and case management system
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• De-escalated problematic customer concerns, maintaining calm, friendly demeanor. Engaged customers to understand needs, resolved issues, and answered product questions, enhancing overall customer satisfaction.
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• Met and exceeded productivity targets by handling every interaction with top-notch customer service. Managed multiple tasks simultaneously to ensure seamless customer service experience in a high-pressure environment.
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• Research systems to find missing information, and coordinate with other departments to resolve issues.
• Formulated insightful questions to identify service requirements and logged data into electronic systems.
• Improved product knowledge on continuous basis to provide optimal service and achieve sales
• Handled inquiries from Veterans regarding diverse topics, ensuring clarity and support.
• Leveraged scripts and program resources to provide accurate information to callers. Understand and follow procedures and processes of the Veterans Affairs (VA) program and perform all tasks in a courteous and professional manner.
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• Protect the health care privacy of patients by strictly following HIPAA regulations.
• Organized and prioritized tasks to consistently meet deadlines in a fast-paced environment. Initiate outbound calls to medical providers and Veterans to provide and update information in their profile records.
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• Consistently meet program productivity and performance goals Phoenix, US
06/2017 to 12/2019
Visalia, US
02/2015 to 12/2016
Peoria, US
Rocket Mortgage
Customer Service Representative (CSR)
Cigna Insurance Companies
Intake/Scheduling Coordinator
VA Healthcare Group
• Expertly handle fee collection and recovery when applicable within the servicing lifecycle Communicated with all parties through written and verbal methods to clarify processes and enhance understanding.
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Understand how the different teams in servicing impact the client experience and can change communication tactics based on the information received
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Identified patterns and trends impacting client experience, providing actionable insights to stakeholders for improved service delivery.
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• Ensure compliance with all investor requirements.
• Analyzes escrow sufficiency to make sure escrowed funds are sufficient to make required payments Execute payments for MI Premiums in batch single processing modes by the installment due dates for each carrier
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• Processed activities and responded to alerts to meet MI timely cancellations.
• Consistently meet minimum quality and production metrics Collaborated with multiple departments to expedite processing and resolve issues, enhancing overall workflow efficiency.
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• Monitored work queues and intervened to ensure timely processing.
• Managed routine communications through calls, emails, and chat to assist clients.
• Initiating third party orders (title, appraisal, hazard, flood cert, credit, etc.) Developed foundational knowledge of mortgage closing transactions, focusing on key documents like mortgages, deeds, and assignments.
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• Proofread and audit recordable documents to be sent to county recorder. Review recordable mortgage closing and title documents to ensure they comply with county requirements and send to county recorder to be placed on land records.
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• Process recording fees by understanding related mortgage documents
• Receive electronic and physical recorded documentation and final title policies
• Report issues related to recording of all Closing documents Resolved administrative eligibility discrepancies through thorough account research and review, ensuring accurate customer support.
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• Maintained accurate records of customer interactions and transactions in CRM system.
• Assisted customers with inquiries regarding insurance policies and benefits.
• Educated clients about claims processes and required documentation for submissions.
• Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
• Processed policy changes and updates efficiently within the system framework.
• Provide one-call resolutions to customers while maintaining acute attention to detail and accuracy. Actively listens to customers, probes for clarification, and provides consultative guidance based upon customers' individual health needs.
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Demonstrate passion and enthusiasm for customer service excellence; maintain focus and positivity while resolving challenging, or complex problems.
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• Enhanced product knowledge to provide optimal service and meet sales quotas. Maintained detailed records of claims, decisions, and financial transactions in compliance with regulatory requirements.
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Utilizes an automated scheduling system to maintain a calendar of services for both episodic and per-visit customers.
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Processed workflow for visits, ensuring timely management of requests, scheduling, missed, rescheduled, reassigned, declined, and delivered visits.
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• Monitors pending referrals daily and assigns a licensed professional (LP) and a case manager for all SOC visits. Communicates daily with field staff regarding any visits that are unaddressed, late, pending, or incomplete for resolution as appropriate.
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• Runs the scheduling request report daily, and completes requests as appropriate for Medicare week. Monitored productivity and distribution of regular visits to optimize caregiver assignments, communicating outcomes with team leader.
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Visalia, CA
Education and Training
Diploma: General Studies
Mt. Whitney High
• Reviews, unverified visit report, daily.
• Communicates directly with field staff, team leader, and branch manager as needed. Continually monitors the action screen and processes all assigned tasks, coordination notes, and admin tasks in a timely manner.
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Assists in the coordination of scheduling and tracking all supervisory visits and therapy reassessment visits, as required by regulatory requirements.
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Attends and participates in annual in-service programs, workshops, continuing educational programs, seminars, etc.
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Maintain the hospital list and follow up on it daily, including scheduling transfers, discharge summaries, and resumption of care visits.
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• Communicated with patients with compassion while keeping medical information private. Reviewed patient referrals from various healthcare facilities to ensure completeness before service initiation. from hospitals, physicians' offices, nursing homes, ensuring that all necessary documents are completed prior to initiating service.
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Evaluated clinical outcomes after each visit to ensure that goals were being met in accordance with standards of practice.
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