ALVIN MORALES

Provides outstanding customer service and supports improvements in operational execution to ensure levels are achieved and exceeded.

RGHV12 Back Office used to verify prior approvals, Customer Insurance and Dr. Information.

Manage customer account activity including, but are not limited to, customer order fulfillment, customer backorders/substitutes, product change requests, new/lost business submissions and coordinating any customer questions/issues that may arise.

Provides outsourced servies to customers relating to invoicing, reimbursement, and/or other services by acting as a liaison in problem-solving, research and problem/dispute resolution.

Collects and reviews customer feedback, complaints, recalls and products returns, working closely with Quality and Regulatory teams.

Identifies customer trends and challenges/opportunities to develop potential alternatives to support business, operational efficiency and develop new customer opportunities.

Communicates with Customers regarding their needs, questions, and concerns and helps trouble shoot equipment issues as necessary.

Manages cases regarding reporting backorders, customer complaints, and pricing and processes product complaint and incident reports.

• Primary responsibilities included but were not limited to the identification and validation of other insurance information as required by Federal and State agencies for the purpose of:
• Minimizing cost and ensuring members’ claims are coordinated properly.
• Ensuring receipt of proper Medicare member premium payments; and
• Educating and enrolling members into Medicaid and Medicare Savings Programs.
• As a Sr. Coordination of Benefits /Escalation Response Specialist III, I ensured accuracy on all other insurance information listed in Xcelys COB History for WellCare’s Medicaid and Dual populations.
• Complete all external department requests for COB validation in less than 5 business days.
• Accurately respond to COB validation requests by thoroughly reviewing existing COB information in Xcelys and reviewing comments provided in COB ticket by requestor and making necessary update actions in Xcelys.
• Add accurate Medicare and/or WellCare Dual coverage information for members in WellCare’s Dual population.
• Verify all Medicare/Advantage Members in the CMS Portal.
• Verify and assist with Escalation Emails, handling problem tickets, and providing feedback to leadership regarding member and/or provider issues.

• Managing Front and back end of operations
• Coordinating staff, training, payroll, and performance
• Observing and ensuring food quality, safety, and service
• Maintaining inventories, supplies, and equipment
• Developing and executing business, marketing, and budget plans
• Adhering to food safety regulations
• Enhancing customer satisfaction and loyalty

• Responsible for training staff of twenty-five eligibility Customer service representatives. Resolved and researched members inquiries regarding prescription orders received via U.S. Mail, phone, or web inquiries. Interacted daily with insurance company’s verifying patient coverage through use of web applications and direct phone calls to members.
• Oversaw quality and performance following standards operating procedures and HIPAA guidelines.
• Promoted customer loyalty and satisfaction by researching then resolving customer inquiries on a supervisory level to ensure proper resolution in a courteous and professional manner.