Alberto Navarro
San Antonio,TX
Summary
Experienced and effective communicator with 15 years of expertise as a Customer Service Representative in a fast-paced call center environment. Handles escalation calls with ease and consistently delivers first call resolution. Personable and dedicated professional with extensive experience in the medical industry, adept at building strong client relationships. Recognized as a solid team player, brings an upbeat and positive attitude to foster rapport within the team. Highly motivated to ensure customer satisfaction and contribute to the company's overall success.
Overview
8
8
years of professional experience
Work History
Member Service Representative (Remote)
Carenet HealthCare
01.2024 - Current
- Make outbound calls and inbound calls from Members to schedule them for wellness visits or virtual appointments, based on their Health insurance company
- Meet numbers for Schedule Conversion and numbers of scheduled visits
- Managed approximately 30 incoming calls per day from customers. Schedule roughly 10-20 scheduled visits per day.
- Maintained high-quality service by adhering to company policies and standards in all member interactions.
Customer Service Representative (Remote)
Glow Touch
11.2023 - 12.2023
- Assisted Provider with Members’ Vision Benefits and Cost
- Assisted Providers with claims details and having claims sent back to reprocessing due to errors
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
Customer Service Representative (Remote)
Evolent HealthCare
06.2022 - 09.2023
- Assist Customers with their Benefit Questions
- Update Customer accounts by updating their Primary Care Physician and ordering new ID cards
- Transfer to Live Wise marketplace to verify changes and cancellations of member’s Coverage.
- Assist Provider and Member Services with benefits and claims questions
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
Medical Claim Representative (Remote)
WellMed
01.2022 - 05.2022
- Work on Claims for different places of service
- Attending Team Meetings and Department Meetings
- Forward claims to the appropriate Dept as needed
- Process up to25-30 claims per hour from a different place of service
- Prioritized workload effectively under pressure, consistently meeting deadlines without sacrificing quality or accuracy in claim processing tasks.
- Managed a high volume of claims, ensuring prompt attention to each case.
- Checked documentation for accuracy and validity on updated systems.
Customer Service Rep (Remote)
TTEC
10.2020 - 01.2022
- Answering customers’ calls about their Bank of America Pre-Paid Cards
- Going over their Government Card Balance, Transaction Details
- Filing Claims for unauthorized transactions, canceling and ordering new cards
- Doing High-Risk Verification and removing Fraud cases and Blocks from their customers’ accounts
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for customers and the company.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Maintained detailed records of customer interactions, contributing to acomprehensive database for future reference.
Customer Service Rep
Aetna Healthcare
11.2018 - 09.2020
- Answering incoming calls from providers regarding member healthcare benefits and claims details
- Verify provider and member information before accessing member accounts
- Look up members’ information in ACD and Rumba and follow all e-policies
- Transfer misdirected calls to appropriate Departments
- End-to-end customer experience
- Obtains and enters data into Aetna systems
- Managed approximately 30 incoming calls per day from customers
Customer Service Representative
Conduent
01.2018 - 09.2018
- Answering Incoming calls from customers in the Bay Area regarding their toll transponders and opening accounts
- Process all updates to their accounts such as credit card information and adding and removing vehicles.
- Assisting in answering questions about their violations and invoices received.
- 'Managed approximately 30 incoming calls, per day from customers.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Assisted customers in navigating thecompany website and placing online orders, improving overall user experience.
Rural Carrier Associate
United States Postal Service
10.2017 - 12.2017
- Sort Mail and Parcels for Delivery
- Deliver mail to the Route that I was assigned to
Hospital Claims Representative Medicare & Medicaid
United Healthcare
08.2016 - 10.2017
- Process incoming claims from Hospitals and Provider Offices
- Verify patient information and hospital codes for billing purposes
- Check all information for denial and paid claims status
- Work will have all the appropriate PI for processing claims
Education
High School Diploma -
San Antonio College
San Antonio, TX05.2034
High School Diploma -
St. Gerard High School
San Antonio, TX05.1994
Skills
- Data Entry, HIPAA, Microsoft Office Products, Medical Terminology, Customer Service Phone and Chat,10 Key by Touch
- Problem-solving abilities, Team Player, handling escalated Calls and De-Escalating them, Back Office Processing
- Customer service
- Relationship building
- Customer support
- Member correspondence
- Healthcare
- Financial transactions
- Call center experience
- Escalation handling
- Banking
- Document processing
Timeline
Member Service Representative (Remote)
Carenet HealthCare
01.2024 - Current
Customer Service Representative (Remote)
Glow Touch
11.2023 - 12.2023
Customer Service Representative (Remote)
Evolent HealthCare
06.2022 - 09.2023
Medical Claim Representative (Remote)
WellMed
01.2022 - 05.2022
Customer Service Rep (Remote)
TTEC
10.2020 - 01.2022
Customer Service Rep
Aetna Healthcare
11.2018 - 09.2020
Customer Service Representative
Conduent
01.2018 - 09.2018
Rural Carrier Associate
United States Postal Service
10.2017 - 12.2017
Hospital Claims Representative Medicare & Medicaid
United Healthcare
08.2016 - 10.2017
High School Diploma -
San Antonio College
High School Diploma -
St. Gerard High School