Ana Avalos
Whittier
Summary
- Healthcare Customer Service Rep with4.5 years’ of working in a call center and medical field
- Well versed in handling high volume of calls, benefits, insurance verification, behavioral health, eligibility, prior authorizations, medical records, medical billing, and coding, data entry, and claims
- Knowledge of HIPAA guidelines and Medical Terminology
- Proficient in MS Office (Word, Excel, Outlook), and other company-based systems or software and able to type40 WPM
- Technical Support
Overview
11
11
years of professional experience
Work History
Customer Service Representative
Elevance
12.2022 - Current
- Improved customer satisfaction by efficiently diagnosing and resolving technical issues.
- Achieved higher customer retention rates through excellent communication skills when explaining complex technical concepts in simple terms.
- Maximized productivity by maintaining an organized work environment and managing multiple projects simultaneously.
- Assisted clients remotely using remote desktop tools, expediting the troubleshooting process significantly.
Call Center Representative (Contract)
UnitedHealth Group
12.2018 - 09.2019
- Answered phone calls and listen to customers' questions and concerns concerning their Health Savings Account
- Answered questions about bank products and try to solve any problems they may have, following the bank's procedures
- Reported Bank Cards that have fraudulent activity
- Authorized to cancel cards that have been reported stolen and reissue new cards to members
- Explained bank fees and discuss options of waiving fees if possible, determining on the members account history
Intake Coordinator (Contract)
New Century Health
01.2018 - 07.2018
- Handled all inbound overflow calls
- Provided Statuses of submitted prior authorizations, provide authorization number and valid dates if approved done via portal or fax to medical offices, hospitals, and providers
- Made outbound calls to providers, medical offices, and hospitals to request medical records and any medical information missing to complete the clinical review for prior Authorization for medical procedures and office referrals for cardiology, oncology, and urology
- Verified medical information to providers if certain Cpt codes or Codes were covered, and if they required prior authorization
Senior Customer Service Representative (Contract)
Optum Health/United Healthcare
11.2015 - 06.2016
- Answered phone calls and listen to customers' questions and concerns concerning their Health Savings Account
- Answered questions about bank products and try to solve any problems they may have, following the bank's procedures
- Reported Bank Cards that have fraudulent activity
- Authorized to cancel cards that have been reported stolen and reissue new cards to members
- Explained bank fees and discuss options of waiving fees if possible, determining on the members account history
Customer Service Representative
Alta Resources
09.2013 - 08.2015
- Handled customer communications phone, and emails with a high level of customer service and maximizing productivity
- Resolved customer service inquiries based on eligibility for benefits, member requests, and physician participation in our networks
- Maintained a working knowledge of products, company policies and procedures
- Handled a high volume of phone calls, emails, and data entry
- Answered Incoming calls from Health Care providers and Members
Senior Customer Service Representative
UnitedHealth Group
11.2014 - 06.2015
- Verified eligibility benefits for behavioral health members
- Explained behavioral health benefits that members have under their insurance plan
- Assisted members in looking for behavioral health providers that are in network as well as out of network
- Checked status of submitted claims that members have sent over
- Handled customer communications phone, and emails with a high level of customer service and maximizing productivity
- Resolved customer service inquiries based on eligibility for benefits, member requests, and physician participation in our networks
- Maintain a working knowledge of products, company policies and procedures
- Handled a high volume of phone calls, emails, and data entry
- Answered Incoming calls from Health Care providers and Members
Education
HS Diploma - undefined
Whittier, CA07.2011
Skills
- Customer service
- Active listening
- Critical thinking
- Data entry
Timeline
Customer Service Representative
Elevance
12.2022 - Current
Call Center Representative (Contract)
UnitedHealth Group
12.2018 - 09.2019
Intake Coordinator (Contract)
New Century Health
01.2018 - 07.2018
Senior Customer Service Representative (Contract)
Optum Health/United Healthcare
11.2015 - 06.2016
Senior Customer Service Representative
UnitedHealth Group
11.2014 - 06.2015
Customer Service Representative
Alta Resources
09.2013 - 08.2015