Ashley Reyes

• Handled all inbound and outbound communications efficiently and professionally
• Handled verification of income, identity, and eligibility documents to support process workflows
• Guide applicant through Medicaid application
• Documented application activities across multiple systems
• Delivered accurate information regarding program qualification standards
• Supported resolution of system errors by documenting issues, escalating to supervisors, and verifying Medicaid coverage accuracy
• Provided bilingual support to customers, resolving inquiries and issues efficiently.
• Collaborated with team members to enhance service delivery and customer satisfaction.
• Processed Medicaid applications efficiently, ensuring compliance with regulations and guidelines..
• Demonstrated excellent customer service skills while assisting diverse populations with various needs related to Medicaid benefits.
• Assisted clients in understanding their Medicaid benefits, explaining complex regulations and policies with clarity.
• Responded to customer concerns and questions on daily basis.
• Resolved discrepancies in member accounts by conducting thorough research and applying appropriate corrective actions as necessary.
• Maintained strict confidentiality of applicant information, adhering to all applicable privacy laws and regulations.
• Providing guidance and directing members to the right departments within local social services.

• Use trained sales techniques to reach company goals of appointments set and customer satisfaction.
• Was recognized has the 2nd agent with most appointment scheduled in the call center for the month.
• Served as a reliable source of information for patients regarding appointment scheduling, insurance coverage inquiries, and general office policies.
• Respond to high volume inbound calls while compassionately handling questions/concerns
• EPMS system
• Strong communication and interpersonal skills, with the ability to build rapport with patients of all ages and backgrounds
• Handled sensitive situations professionally such as discussing treatment and costs
• Communicated with office clinic to confirm patinet information.
• Enabled effective communication between doctors, office staff and patients with limited English proficiency by interpreting dental appointments accurately and treatments.
• Assisted patients and families in understanding our dental services, Dental specialist available, pricing and promotions
• Kept track of daily calls received to ensure that the monthly percentage was met.
• Received monthly incentives for reaching company goals.
• Documented work activities diligently, providing accurate records for management review and future planning purposes.
• Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic.
• Actively participated in team meetings focused on improving workflows and enhancing overall practice performance.
• Provided compassionate support for patients facing financial challenges, assisting them in navigating available resources and payment options.
• Recommended service improvements to minimize recurring patient issues and complaints.

• Primary duty is to provide quality member services to members by performing transactions that are requested by members or answering their questions, which may be related to their account history or member service, loan, mortgages, VyStar Investment Services products ect,
• Assisted member with financial needs such has to fund transfer, wire transfer, All type of payments, Refunds, collection inquiries, Internet Banking PIN reset and trouble shoot, stop payments, Check deposits, Order check, Bill pay, debit and credit card disputes, Open Certificate of Deposit accounts or other savings accounts, resolve account issues, cancel or order new cards etc
• Expected to attain a firm knowledge of VyStar’s products and services in addition to policies and procedures to effectively offer products based on members’ needs
• Exhibit courteous and professional telephone etiquette in all member contacts while conducting effective fact finding to understand member’s needs and issues and making independent and appropriate decisions in resolving members’ problems as well as in offering appropriate products
• Learned internal systems and related service role duties to provide skilled team backup in handling customer demands.
• Continuously surpassed customer service standards while ensuring compliance with call volume objectives
• Recommended specific products and services in alignment with individual needs, requirements and specifications
• Responded to customer calls and emails to answer questions about products and services and/or follow ups regarding member request
• Delivered functionality assistance via phone and live chat service platforms
• Identified potential fraud patterns through meticulous analysis of dispute cases and account histories.
• Handled sensitive situations professionally, demonstrating empathy towards customers while enforcing company policies fairly.
• Managed multiple cases simultaneously with strict attention to detail, ensuring accurate outcomes within tight deadlines.
• Educated customers on digital banking features, facilitating seamless transitions from traditional banking methods.
• Collaborated with other banking staff to deliver exceptional customer service across all channels.

Customer Service Representative III

• Answer Inbound calls and assist individuals gain healthcare coverage through New York State of Health Marketplace via telephone applications, including the general public, prospective enrollees and people assisting enrollees,(CAC & BROKERS)
• Process life event changes, demographic updates, disenrollment requests, and special enrollment periods as requested. Educate consumers on health insurance, healthcare documents, privacy policies including building tax household, household income, eligibility determinations, interpreting determinations made by the Marketplace, and enrollment into health plans.
• Attends meetings and trainings as requested and maintains up-to-date knowledge of all programs and systems.
• Participated in Shadower/Mentor program and trained new hires on customer service, quality, processing individuals health coverage in the marketplace, and achieving Maximus goals
• Promoted for outstanding performance

Account Review Administrator

• Process appeals and complaints for enrollments and eligibility for health coverage via New York State of Health benefit exchange. Track and document all inquiries using the applicable systems.
• Deescalate and handle upset callers using professional customer service
• Determines and takes appropriate account corrective actions. Reprocesses applications including account correction and missing information responses in an accurate and timely manner
• Maintains an understanding of the NYSOH Enrollment and Eligibility and Call Center processes and policies for the individual and SBM Marketplace policies
• Responds to forwarded, written (email and task driven) and oral (phone) requests/complaints from clients pertaining to some aspect of their account that they do not understand or agree with, as assigned
• Processes informal dispute resolution (IDR), appeals and complaints for enrollment and eligibility for health coverage via the NYSOH Marketplace
• Reviews, Assess and Processes requests for backdating of enrollment. Meets all performance requirements associated with Eligibility & Enrollment processes (Medicaid, Essential Health Plan, APTC, CHIP.
• Schedule Appeal Hearings utilizing approved client schedules
• Explain individual appeal processes
• Live translation of English to Spanish,
• Facilitate translation services for non-English speaking callers according to procedures.
• knowledge of systems to assist individual on eMedNY, Sibel, Back Office.
• Met quality metrics month to month and was recognized as excellent agent of the month.
• Examined claims forms and other records to determine insurance coverage and more.
• Resolved issues through active listening and open-ended questioning, escalating major problems to manager
• Troubleshot minor issues with office tools and equipment, escalating more serious problems to supervisor
• Educated individual on health plans benefits, copays, deductible and premium.
• Educated individual of Medicare coverage and referred to appropriate department
• Assisted member by searching for Doctors/Clinics for specific needs.
• Referred individuals to appropriate departments/health and public assistance programs/Facilities.
• Determine the best path for document problem resolution
• Ability to identify risk and escalate to management
• Ability to work as a team member, as well as independently
• Ability to learn new software programs
• Ability to type and process material in an expeditious manner.

• Worked 40hours weekly.
• Demonstrated excellent multi-tasking skills
• Primary job duties include unloading shipments, restocking, and organizing items as necessary and directed
• Gained interpersonal skills while dealing with a mass number of everyday customers
• Learned how to maintain high visibility and energy levels on the shop floor and adapt to immediate or unforeseen challenges
• Worked with different departments
• Computer proficiency in Microsoft Word, Excel, and Outlook.
• Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
• Responded to customer requests for products, services and company information