Armando Ramirez
San Antonio,TX
Summary
Seasoned customer service professional with over 15 years of experience across healthcare, e-commerce, and HR support. Skilled in handling high-volume calls and providing timely, empathetic service solutions in fast-paced environments. Expert in maintaining confidentiality and using in-depth problem analysis and resolution skills to boost customer satisfaction and loyalty. Adept at coordinating services and managing claims, demonstrating a comprehensive ability to meet diverse customer needs.
Overview
11
11
years of professional experience
Work History
Program Coordinator I
Superior Health Plan
San Antonio , TX
06.2024 - 10.2024
- Managed and initiated authorization requests, ensuring compliance with authorization lists.
- Research claims inquiry specific to the department and responsibility.
- Perform tasks necessary to promote member compliance, such as verifying appointments and obtaining lab results.
- Assess and monitor inpatient census.
- Screen for eligibility and benefits.
- Identify members without a PCP and refer to Member Services.
- Screen members by priority for case management (CM) assessment.
- Perform transition of care duties, including but not limited to contacting the member's attending physician, member, or medical power of attorney, and other medical providers (home health agencies, equipment vendors), for information pertaining to special needs.
- Coordinate services with community-based organizations.
- Attend marketing and outreach meetings, as directed, to represent the plan.
- Produces and mails routine CM letters and program educational material.
Benefit Services
Boon Group
New Braunfels , TX
02.2024 - 06.2024
- Answering a high volume of inbound calls and maintaining a rapid response rate according to the agreed/standard metrics.
- Maintained professional and efficient relationships with team members and supervisors to enhance service delivery.
- Maintain knowledge of health claims, coding, and processing guidelines.
- In addition, maintain knowledge of plan designs, PPO networks, indemnity plans, and all other contracts and services.
- Researching and resolving customer inquiries.
- Search for doctors, clinics, and other healthcare facilities that suit the members' needs most accurately.
- Conduct further communication with the providers.
- Completing forms for follow-up with other departments.
- Advising department or unit of possible issues by trending types of calls received.
- Performing other duties as assigned.
Health Concierge Customer Service
IBA
New York , NY
04.2023 - 11.2023
- Receive inbound calls supporting patients, pharmacies, and medical professionals.
- Ensure that provider information is loaded accurately to allow for proper claims processing, outbound reporting, and directory updates.
- Educate and inform customers or medical professionals via multiple communication channels about documentation requirements, time frames, payment information, claim status, and benefits.
- Review member claim history to ensure accurate tracking of benefits applied, including, but not limited to, maximums and/or coinsurance and deductible.
- Guide members through their plan of benefits.
- Follow up with customers to ensure their issue has been resolved to their satisfaction.
- Confidently answer escalated customer inquiries, or route them to the agent best equipped to respond.
- Complete intake calls to welcome members to the program.
Customer Service Agent
eBay
Austin , TX
07.2022 - 03.2023
- Interact with customers via multiple channels (email, chat and phone) to address inquiries, resolve issues, and provide guidance on the usage.
- Review accounts, assist members with payment issues/questions, as well as identify potential risky fraudulent activity.
- Take appropriate action for eBay to ensure a safe and compliant trading platform for our community.
- Stay up to date with product and service information, and promotions.
- Provide engaging and compassionate customer service in a dynamic call center environment, focusing on making and receiving payments.
- Implement conflict management skills to de-escalate calls that build positive customer experience.
- Provide accurate information about products and services to customers.
- Gather customer feedback and insights to share with the product development team, contributing to continuous improvement.
- Maintain high-performance metrics, including quality, adherence, and customer satisfaction.
- Experience troubleshooting product bugs or quality issues with customers and development teams.
Customer Service Representative II/Provider Services
Centene Corp
San Antonio , TX
08.2017 - 06.2022
- Answer incoming phone calls from healthcare providers and members to research billing inquiries, claims status, payment details, provider complaints, claim processing, appeals, and various operational concerns in a timely manner.
- Educate members on disease management programs, health plan initiatives such as Silver Sneakers, over-the-counter benefits, transportation, meals, and making other recommendations for resources that may benefit their care, and discuss other follow-up needs.
- Connect clients with the most appropriate services based on their needs, eligibility, and geographic preference.
- Knowledge and experience in accessing community resources to help customers with basic needs.
- Load and maintain provider information into computer systems with attention to detail.
- Reference current materials to answer escalated and complex inquiries.
- Assist members and/or providers regarding website registration and navigation.
- Provide first-call resolution.
- Document all activities for quality and metrics reporting through the Customer Relationship Management application.
- Empowered members to understand their health insurance and how to use it, including assisting in locating urgent care clinics, providers, specialists, and getting precertification for specific services.
Customer Care Representative II
QTC Medical Services
San Antonio , TX
03.2015 - 08.2017
- Provide clients with world-class customer service by determining call requirements, responding to inquiries, resolving customer issues, and fulfilling customer requests.
- Schedule appointments for examinees, including initial, follow-up, and rescheduled appointments.
- Clarify customer inquiries through active listening to research, locate, and provide information to the appropriate entities.
- Maintain ownership of calls, including outreach or follow-ups with the escalation team or department leadership.
- Accurately documents all call information in case management system, according to standard operating procedures.
- Efficiently utilizes tools and available resources such as eProcess, Compass/APAS, OneNotes, PRM, and other tools as necessary.
- Demonstrate compassion and professionalism when addressing complex inquiries and/or irate callers.
- Recommend improvement ideas for systems to improve organizational efficiency.
HR Support Center Representative
University of North Texas
Forth Worth , TX
06.2013 - 10.2014
- Received inbound calls, answered general inquiries using knowledge of current HR procedures and practices.
- Display a high level of responsiveness to customers' needs, always maintaining excellent customer service skills.
- Incredibly knowledgeable regarding the organizational structure of all UNT System institutions, HRIS systems, and policies and procedures.
- Review human resources forms such as I-9, FMLA, Onboarding, ePAR, Benefits, and assisted with completion.
- Compiled information and prepared reports as needed.
- Reviewed prior state service information and updated systems as needed.
- Provided employment verifications.
- Scanned paper documents into appropriate workflow (files), which included sorting, researching, and preparing paper documents for scanning.
- Maintained electronic file integrity, which included scanning for readability, checking for misfiled documents, and removing duplicate documents.
Education
GED -
New Braunfels High School
New Braunfels, TX12-1993
Skills
- Problem Analysis
- Problem solving
- Organizational skills
- Customer service orientation
- Adaptability
- Medical terminology
- Team Player
- Claims Management
- Care coordination
- Eligibility Determination
- Program Optimization
- Resource Management
Timeline
Program Coordinator I
Superior Health Plan
06.2024 - 10.2024
Benefit Services
Boon Group
02.2024 - 06.2024
Health Concierge Customer Service
IBA
04.2023 - 11.2023
Customer Service Agent
eBay
07.2022 - 03.2023
Customer Service Representative II/Provider Services
Centene Corp
08.2017 - 06.2022
Customer Care Representative II
QTC Medical Services
03.2015 - 08.2017
HR Support Center Representative
University of North Texas
06.2013 - 10.2014
GED -
New Braunfels High School
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