August Torres
Hammonton,NJ
Summary
Personable and dedicated Customer Service Representative with extensive experience in health insurance industry. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Benefits Specialist
South Jersey Industries
Folsom, NJ
05.2023 - Current
- Researched and resolved employee inquiries regarding benefits programs.
- Processed benefit enrollment forms, changes, and terminations.
- Reviewed eligibility for medical insurance coverage and other benefit plans.
- Developed training materials to educate staff on benefit plans available to them.
- Assisted employees with enrolling in benefit plans and explained plan options.
- Resolved employee issues related to benefits, serving as a liaison between employees and insurance providers.
- Administered employee insurance, pension and savings plans, working with insurance brokers and plan carriers.
- Maintained detailed records of employee benefits enrollments and changes for auditing and reporting purposes.
Retiree Advocate IV
Labor First
Mt. Laurel, NJ
06.2021 - 04.2023
- Communicating with members, doctors, and pharmacies
- Interacting with clients and insurance companies
- Handle escalated calls from members
- Develop creative solutions to member issues
- Entering and updating data in salesforce software
- Maintaining, expanding, and servicing existing clients
- Ensuring exceptional customer service
- Problem solving capabilities and quick thinking
- Ability to travel for retiree meeting and events
- Perform other duties and special projects as assigned
- Knowledge of Medicare administration and Medicare Guidelines
- Assist member service manager with team
- Assist team with questions to their specific assigned groups
IVIG Onboarding Specialist
Option Care Home Infusion
Chicago, IL
04.2015 - 05.2021
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Notified ordering providers of denied authorizations.
- Coordinated resolutions for issues and appealed denied authorizations.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Used Citrix software to input claim, prior authorization and other important medical data into system.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Maintained files for referral and insurance information, entering referrals into system.
Insurance Verification Specialist
Option Care Home Infusion
Chicago, IL
05.2014 - 05.2015
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Updated patient and insurance data and input changes into company computer system.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
- Liaised between physician, site of service and billing department to obtain appropriate documentation.
- Contacted patients to arrange payment arrangements for deductible and out-of-pocket liability.
- Navigated through multiple online systems to obtain documentation.
- Entered data in EMR database to record payer, authorization requirements and coverage limitations.
- Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Performed verification of Medicare coverage.
Medical Technician
Lourdes Cardiology
Hammonton, NJ
05.2012 - 05.2014
- Documented and updated patient data on electronic medical charts, maintaining accuracy and confidentiality.
- Observed and recorded vital signs and reported changes to physicians or nurses.
- Provided excellent patient support and care to patients and families.
- Monitored medical supply inventory to ensure consistent availability of critical items.
- Cleaned and sterilized laboratory equipment to prevent cross-contamination.
- Performed EKG's on patients
- Electronically sent prescription refills to pharmacy
Call Center Customer Service Representative
Southern Jersey Family Medical Center
Hammonton, NJ
05.2011 - 05.2012
- Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
- Answered incoming calls and provided highest level of professionalism and knowledgeable service to every customer.
- Met or exceeded call speed, accuracy and volume benchmarks on consistent basis.
- Built sustainable relationships and engaged customers by going extra mile.
- Engaged actively with callers, confirming or clarifying information and diffusing anger.
Assistant Office Manager
Advanced Spine And Pain Center
Hammonton, NJ
05.2008 - 05.2010
- Monitored office inventory to maintain supply levels.
- Trained team members in administrative procedures and tasks to keep team efficient and consistent.
- Collected and coded various documents to prepare for filing, storage and processing.
- Administered payroll and maintained proper documentation of employee personnel.
- Managed office inventory and placed new supply orders.
- Handled scheduling and managed timely and effective allocation of resources and calendars.
- Completed disability forms for patients
- MVA precertification
- Pre-certifications for MRI and Cat scans
- Appeals for Medical Health Insurance
Pharmacy Technician
Kessler Memorial Hospital
Hammonton, NJ
05.2000 - 05.2009
- Teamed with peers, technicians and pharmacists to prioritize and complete orders.
- Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems.
- Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
- Interpreted and processed medication orders under supervision of pharmacist.
- Inspected medication storage locations to monitor drug expiration dates and supply adequate inventory.
- Liaised with pharmacist to measure and prepare medication doses and packaging and label prescriptions.
- Maintained pharmacological practices by checking drug inventory, stocking medications and monitoring supplies.
Clinical Assistant
Kessler Memorial Hospital
Hammonton, NJ
05.2000 - 05.2001
- Interacted closely with practitioners, nurses and patients and used effective interpersonal, active listening and communication skills.
- Assisted patients with basic care and provided excellent service.
- Recorded vital signs and medical history for patients each shift.
- Recorded patient medical histories, updated charts and obtained insurance approvals as appropriate.
- Collected information to aid physicians in treating patients' needs.
- Transcribed doctor's orders to patient's charts and setting up tests, and lab work
Education
Medical Assistant
Atlantic County Institute of Technology
Mays Landing, NJ06.1998
Nursing Science
Atlantic Cape Community College
Mays Landing, NJSkills
- Call Center Operations
- Customer relations
- Office equipment proficiency
- Employee coaching
- Inbound and Outbound Calling
- Senior leadership support
Certification
- Real Estate License - 2018
- NJ Accident and Health Producer License- 2022
Timeline
Benefits Specialist
South Jersey Industries
05.2023 - Current
Retiree Advocate IV
Labor First
06.2021 - 04.2023
IVIG Onboarding Specialist
Option Care Home Infusion
04.2015 - 05.2021
Insurance Verification Specialist
Option Care Home Infusion
05.2014 - 05.2015
Medical Technician
Lourdes Cardiology
05.2012 - 05.2014
Call Center Customer Service Representative
Southern Jersey Family Medical Center
05.2011 - 05.2012
Assistant Office Manager
Advanced Spine And Pain Center
05.2008 - 05.2010
Pharmacy Technician
Kessler Memorial Hospital
05.2000 - 05.2009
Clinical Assistant
Kessler Memorial Hospital
05.2000 - 05.2001
Medical Assistant
Atlantic County Institute of Technology
Nursing Science
Atlantic Cape Community College
- Real Estate License - 2018
- NJ Accident and Health Producer License- 2022
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