Carlas Mena
Summary
Efficient professional with over 5 years of work experience and a proven knowledge of customer needs assessment, detailed professional with expertise in disability, records management, billing, enrollment, and data entry. Frequently praised as hard-working by peers, prepared to follow directions and challenging tasks. I'm currently seeking to utilize my extensive professional experience & knowledge at a new opportunity.
Overview
5
5
years of professional experience
Work History
Specialist Policyholder Support II
The Standard
04.2024 - Current
- Screened and processed forms from Sales and Underwriting for new and re-classified groups, utilizing my comprehensive understanding of benefits to discern the specific needs of our group and members within our system.
- Updated companies records meticulously documented outcomes for precise tracking and analysis.
- Managed enrollment inquiries, handled benefit verifications, and accurately recorded and implemented necessary modifications.
- Managed premium billing, conducted audits, and maintained efficient communication with clients to ensure timely issue resolution.
Membership L&D Enrollment & Billing
Elevance Health
02.2022 - 03.2024
- Maintained detailed and accurate records between databases and programs such as Salesforce, compass, and publishing.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Proved successful working within tight deadlines and a fast-paced environment.
MLTC Customer Care
Elevance Health
09.2021 - 01.2022
- Analyzed and resolve members' complaints using applicable resources and systems.
- Worked with over 100 patients to ascertain issues making referrals to appropriate specialist.
- Maintained accurate documentation of all clinical interventions conducted within the managed care setting.
- Ensured compliance with state and federal regulations, maintaining a thorough understanding of evolving legislation impacting pharmacy services.
Customer Services Rep III
Maximus Inc
05.2020 - 08.2021
- Kept patient information confidential and rights private in compliance with HIPAA.
- Conferred and cooperate with management and implementing administrative. Reviewed applications for different aid programs.
- Verified client information by analyzing existing evidence on file and managed over 60 insurance verifications
- Maintained up-to-date knowledge of industry trends, ensuring the ability to provide relevant advice to customers as needed.
Education
Associate - In Science In Human Services
Bronx Community College
New York, New York01.2021
Skills
- Administrative Support
- Calm and Professional Under Pressure
- Customer Data Confidentiality
- Office Suites
- Excellent Attention to Detail
- Application processing
- Analytical thinking
- Document review
- Enrollment verification
- Quality assurance
- Multitasking and organization
- Documentation and reporting
Personal Information
Title: Policyholder specialist/Customer Service
Languages
Spanish
Native or Bilingual
Timeline
Specialist Policyholder Support II
The Standard
04.2024 - Current
Membership L&D Enrollment & Billing
Elevance Health
02.2022 - 03.2024
MLTC Customer Care
Elevance Health
09.2021 - 01.2022
Customer Services Rep III
Maximus Inc
05.2020 - 08.2021
Associate - In Science In Human Services
Bronx Community College
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