Health Care Claims Specialist/ Customer Service
Laguna
With my 16 years of experience as customer service representative /claims specialist I am used to handling escalated calls and making sure that I stayed calm under pressure, and providing the best resolution for every complaint received. Making sure that the callers felt heard and supported. I'm also very detail-oriented which is important when discussing insurance information because accuracy matters. I'm also someone who learns quickly and takes feedback seriously to improve my performance. I focus on providing great service while meeting company goals, and I try to be dependable and team oriented. I believe these qualities can help me contribute positively to your company
ResultsCX, full_time
Apr 2015 to Nov 2025
*Owns escalated customer issues from start to finish, checking root cause analysis to resolve complaints and prevent recurring issues. *Maintain records of customer interactions, case details and final resolution in the system. *Processed and correct claims if deemed necessary. *Analyse trends in escalated calls and provides feedback to management to improve customer service and reduce escalated calls. *Participated in ongoing training to enhance job skills and knowledge. *Make outbound calls to update customers regarding unsolved issue. *Assist in chat service if needed *HIPPA compliant.
ResultsCX, full_time
Feb 2009 to Apr 2015
*Developed strong customer relationship and loyalty through effective communication. *Handles a wide range of customer inquiries, complaints and requests with a focus on accurate resolution. *Tracked all incoming calls from customers using appropriate applications and recording information appropriately. *Provides eligibility and benefit coverage of the member. *Assist with claims inquiry *Follows HIPAA compliance