Open To Work
CAROLINA SANCHEZ
Orion First Financial - Concord Servicing, LLC
Tampa,FL
1
Language
1
Certification
23
Years of experience
Bilingual English/Spanish Customer Support Specialist with extensive experience in insurance verification and financial account servicing. Delivers accurate records and effective issue resolution while ensuring compliance and customer satisfaction. Skilled in data analysis, project management, and strategic planning, with a proven ability to communicate and solve problems in fast-paced environments.
Work History
Remote Service Advocate III position for the MRU (Receivables Medical Records Unit) (TEMPORARY-PROJECT)
1 Year 4 Months- The Customer Service Advocate provides service excellence by accurately examining, researching, and effectively communicating information to our providers. The Customer Service Advocate maintains a professional relationship with multiple internal Florida Blue partners by interacting and coordinating to ensure positive business results and relationship building. Provide excellent customer service to our providers by sending Medical Record Requests and ensuring they are timely
- Communicated clearly to enhance customer understanding of company products and services.
- Perform thorough research using multiple systems.
- Tracked and resolved cases, ensuring adherence to established timelines and contributing to timely customer support.
- Navigated applications to conduct thorough research and deliver accurate information to providers.
Remote Bilingual Provider Services Advocate (TEMPORARY-PROJECT)
1 Year 4 Months- Provided service excellence by examining, researching, and communicating information to providers. The Provider Service Advocate maintains a professional relationship with multiple internal Florida Blue partners by interacting and coordinating to ensure positive business results and relationship building. help the Company's customers utilize products, tools, and services and directly contribute to customer satisfaction and retention.
- Provide customer service and education to providers by answering more complex questions regarding insurance claims, resolving issues, and ensuring customers understand the Company's products, services, and processes.
- Conducted research to address inquiries and interpreted policy provisions, ensuring accurate and effective responses.
- Responded to provider inquiries via Availity Messages and Client Letter correspondence, consistently meeting corporate guidelines and performance standards.
- Utilized computerized systems for tracking and gathering information related to provider inquiries. for tracking, information gathering, and troubleshooting.
- Sought, identified, and implemented process improvements to enhance service delivery and provider satisfaction.
Remote Bilingual Financial Customer Svc.Specialist
3 Years 1 Month- Supported borrower accounts across Orion First Financial and Concord Servicing loan portfolios.
- Spoke with borrowers about payments, account changes, and resolution options.
- Updated account records to support compliant financial servicing operations.
- Entered customer requests into servicing systems and case tracking tools.
- Coordinated with internal teams on escalated account issues and corrections.
- Applied company policies to handle billing, delinquency, and payment adjustments.
- Documented customer interactions and servicing actions in financial records.
- Provided technical support for customers in resolving complex issues.
- Assessed customer needs quickly to provide appropriate solutions.
- Analyzed customer needs and recommended appropriate products or services.
- Assisted in developing strategies to increase customer satisfaction levels.
- Created training materials for new hires on the company's procedures and policies.
- Researched and analyzed customer feedback to identify areas of improvement.
- Developed and implemented specialized procedures for customer service operations.
- Maintained accurate records of customer interactions and feedback.
- Implemented process improvements to increase efficiency and reduce costs.
- Generated reports to track performance metrics of team members.
- Performed quality assurance testing on newly developed software applications.
- Reviewed documents for accuracy prior to submission or publication.
- Set specific goals for projects to measure progress and evaluate end results.
- Utilized document management system to organize company files, keeping up-to-date and easily accessible data.
- Identified areas for improvement, narrowing focus for decision-makers in making necessary changes.
- Created plans to propose solutions to problems related to efficiency, costs or profits.
Temporary Contractor PSC Rep II (100% Remotely)
4 Months- Facilitated pre-registration and financial clearance to ensure smooth facility appointments.
- Conducted insurance verification.
- Obtained authorization from insurance companies.
- Scheduled patient appointments and registered them efficiently in the system.
- Collected financial responsibilities, including co-insurance and co-payments, to ensure compliance and minimize payment delays.
- Oversaw KPIs (Key Performance Indicators) like customer satisfaction and account resolution to monitor performance and maintain service quality.
Provider Contracting & Negotiating Specialist
6 Months- Negotiated fees and rates with out-of-network providers to establish agreements.
- Negotiated out-of-network claims for clients, establishing single case agreements or direct contracts with providers while initiating contact for out-of-network services.
- Work directly with clients and other departments on negotiation requests.
- Corresponded with providers via phone, email, and fax, accurately recording contact and progress for each case.
- Executed data entry and documentation processes for the repricing of medical claims.
- Oversee the process to ensure the claim is adjudicated.
- Managed team mailbox to ensure timely responses and support for negotiation requests.
Grievance Coordinator, Ops-Complaint (TEMPORARY-PROJECT)
2 Months- Responded to member and provider inquiries via telephone, correspondence, or lobby walk-ins, meeting corporate guidelines and performance standards. Demonstrated customer-care skills such as empathy, active listening, courtesy, and helpfulness while recording investigations and resolving member complaints per Grievance Procedure narrative.
- Assisted in resolving member and provider complaints, making decisions that aligned with win-win outcomes for members, associates, and WellCare while demonstrating initiative, accountability, and value to enhance customer experience.
- Educated new members and re-educated existing members on health plan procedures, tracking grievance cases by line of business for compliance and review.
Customer Service Representative - Help Desk Service
1 Year 9 Months- Bilingual Proficient Fluency Spanish & English-Speaking Customer Service Expertise
- Facilitated translation services for all company departments
- Responsibilities in the Customer Service Department include:
- Handled client calls to confirm information or create new client files, ensuring accurate records.
- Updating client's account information for various department
- Conducted insurance verification through portals and eligibility sites to facilitate client services.
- Following an intake format to make sure all relevant information is gathered at the time of the call.
- Performed accurate data entry of client information, appointment dates, and related notes to maintain up-to-date records.
Administrative Coordinator /Case Management Processor for the Case Management Team
9 Months- Supported Case Management staff by managing departmental processes and facilitating non-clinical activities to enhance workflow.
- Strong customer service skills in coordinating service delivery including attention to members/customers, sensitivity to concerns, proactive identification, and resolution of issues to promote positive outcomes for members
- Managed Case Management Team activities related to denial and recoupment issues
- Ensured compliance with denial management system, contributing to effective tracking and reporting of denials.
- Initiated clinical review requests to the Utilization Reviewer Case Managers
- Communicated with insurance representatives regarding admissions, authorizations, and denials
- Coordinated evaluation and processing of insurance claims to ensure timely resolution and adherence to protocols.
- Escalated complex clinical review requests to appropriate parties for timely resolution.
- Prepared decision support data reports for physician and hospital quality/utilization meetings
Provider Operations Coordinator (TEMPORARY-PROJECT)
3 Months- Verified patient insurance, coverage, and PIP medical billing while supervising staff to ensure compliance and efficient operations
- Maintained and updated AHCA-required logs monthly to ensure regulatory compliance and operational accuracy
- Verified medical staff credentials, background checks, and status of medical liability insurance
- Review each credentials application packet for completeness and request missing data
- Assisted practitioners with hospital contract negotiations and conducted group presentations to facilitate agreements
Cardinal Health eRecovery, Bilingual Lead Representative
5 Years 10 Months- Managed applications to pharmaceutical manufacturers' "Patient Assistance Programs" ensuring recovery of medications for indigent cancer patients lacking third-party coverage.
- Served as liaison among doctors, patients, pharmaceutical companies, hospitals, insurance providers, and case managers to facilitate coverage status inquiries.
- Verified physician credentials prior to submitting enrollment forms to drug companies, ensuring compliance and accuracy in the application process.
- Verified patient billing information with Medicaid & Medicare along with State insurance coverage according to hospital policy prior to submission of enrollment to drug companies.
- Maintained security and confidentiality of patient information related to the functions and activities of the medication recovery program for the month-end report
- Verified credentialing status of medical doctor in practice.
Education
Diploma
High school diploma
Skills
Bilingual proficiency Face-to-Face & Telephonic Interpreter
Healthcare expertise
System expertise
Claim processing systems
Loan servicing systems
Salesforce development
Leaseworks | NLS SOR
NLS Systems
DevOps & Cloud Engineering
Insurance verification
Claims adjudication
Case tracking
Provider contracting
Written communication
Problem solving
Languages
Spanish
Native/ Bilingual
Certification
- CMA Certification, Eastwick College – Diploma Hackensack School of Business - Hackensack, NJ 2003
Timeline
Remote Bilingual Financial Customer Svc.Specialist
Orion First Financial - Concord Servicing, LLC
08.2023 - 09.2026Read More
Temporary Contractor PSC Rep II (100% Remotely)
Conifer Health Solutions
01.2023 - 05.2023Read More
Provider Contracting & Negotiating Specialist
Leading Edge Administrators
03.2022 - 09.2022Read More
Remote Service Advocate III position for the MRU (Receivables Medical Records Unit) (TEMPORARY-PROJECT)
Glidewell/Blue Cross Blue Shield of Florida
08.2020 - 12.2021Read More
Remote Bilingual Provider Services Advocate (TEMPORARY-PROJECT)
Glidewell/Blue Cross Blue Shield of Florida
08.2020 - 12.2021Read More
Grievance Coordinator, Ops-Complaint (TEMPORARY-PROJECT)
Insight Global - WellCare Healthcare Plans
03.2020 - 05.2020Read More
Customer Service Representative - Help Desk Service
Custom Mobility
05.2018 - 02.2020Read More
Administrative Coordinator /Case Management Processor for the Case Management Team
Bayfront Health Hospital St. Petersburg
03.2017 - 12.2017Read More
Provider Operations Coordinator (TEMPORARY-PROJECT)
WellCare Healthcare Plans - 4 Corner Resources
09.2016 - 12.2016Read More
Cardinal Health eRecovery, Bilingual Lead Representative
Trinitas Regional Medical Center/St. Joseph's Regional Medical Center/University Hospital
02.2010 - 12.2015Read More
Eastwick College
Diploma
Read More
Hackensack School of Business
Read More
Grover Cleveland, H.S.
High school diploma
Read More