Anastacia Rivera
Jacksonville,NC
Summary
Versatile and client-focused Customer Service Professional with a proven track record across health insurance operations and high-volume service environments. Skilled in complex issue resolution, active listening, and administrative organization using tools like Microsoft Excel. Recognized for strong interpersonal communication, adaptability, and maintaining high accuracy in fast-paced settings
Overview
1
1
Language
1
1
Certification
6
6
years of professional experience
Work History
Waitress
Highway 55
Jacksonville, North Carolina
04.2020 - 01.2021
- Delivered food and beverages promptly to elevate dining experience.
- Provided menu recommendations during order taking to boost customer engagement.
- Coordinated with kitchen staff to deliver timely service and enhance customer satisfaction.
- Supported team during peak hours to optimize service flow.
- Maintained cleanliness of dining area and tables to foster a welcoming environment.
- Supported setup and closure of restaurant operations, facilitating smooth transitions.
- Processed payments accurately, ensuring efficient cash register operations.
- Initiated customer interactions to enhance overall dining experience., addressed inquiries, and recommended specials to enhance profitability.
Customer Service Representative
Results Companies
Fort Lauderdale, Florida
09.2022 - 07.2026
- Resolved high-volume inquiries from health plan members, healthcare providers, and brokers regarding benefit coverage, claims status, pre-authorizations, and eligibility.
- De-escalated frustrated members during sensitive calls, connecting them with care managers or urgent resources to ensure timely support.
- Guided members through open enrollment and plan selection, facilitating PCP changes and navigation of online portals and pharmacy benefits.
- Investigated and resolved complex billing issues, claim denials, and copay/deductible discrepancies, ensuring compliance with Medicaid, Medicare, and Managed Care guidelines.
- Managed member accounts using CRM software and healthcare management systems, accurately documenting interactions for auditing and care continuity.
- Maintained strict confidentiality and protected health information (PHI) in accordance with HIPAA regulations and company privacy standards.
Education
High School Diploma -
Jacksonville High School
Jacksonville, NC06-2020
Bachelor of Education - Teaching English As A Second Language
Liberty University
Lynchburg, VA08-2026
Skills
- Customer relationship management
- Payment processing
- Claims & Billing Inquiry Resolution
- Health Insurance Benefits & Eligibility Verification
- Medicaid, & Qualified Health Plans (QHP)
- Healthcare compliance
- HIPAA Compliance & PHI Security
- Care coordination
- CRM & Electronic Health Record Systems (EHR)
- Call Center Operations & Multi-Line Telephones
- De-escalation & Conflict Resolution
- Problem Solving & Analytical Thinking
- Data Entry and Accurate Documentation
- Time Management & Multi-Tasking
- Active Listening & Compassionate Communication
- Written & Verbal Communication
- Service optimization
Certification
- HIPAA Compliance & PHI Security Certification
- Department of Health (DOH) Managed Care & Compliance Training Certification
- Cybersecurity & Threat Awareness Certification
- Microsoft Excel Professional Development Training Certification
Languages
English
Full Professional
Timeline
Customer Service Representative
Results Companies
09.2022 - 07.2026
Waitress
Highway 55
04.2020 - 01.2021
High School Diploma -
Jacksonville High School
Bachelor of Education - Teaching English As A Second Language
Liberty University