Caroline I. Garcia
Summary
Seeking a Position Where I Can Utilize My Healthcare Experience to Provide Excellent Customer Service
Healthcare professional with proven track record in patient care, communication, and problem-solving. Strong focus on team collaboration and adaptability to changing needs. Possesses key skills in patient advocacy, medical documentation, and customer service. Known for reliability and delivering high-quality results in fast-paced environments.
Overview
26
26
years of professional experience
Work History
Claims Analyst
Centene
08.2022 - Current
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
Claims Representative
LifeCare Assurance Company
03.2020 - 07.2022
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
Customer Service Representative
Aetna Dental
04.2007 - 10.2019
- Answers questions and resolves issues related to survey calls, inbound and outbound call center for medical and dental plans
- Records survey responses in the First Call Resolution (FCR) Access Database
- Ensures FCR reports in the database are maintained and resolved
- Performs service recovery for the member/provider and documents actions taken and required follow-up to resolve situation/answer inquiries online chat responses for members
- Escalates issues accordingly when further action requires secondary sources or more senior staff
- May process claims or take inbound calls when applicable/authorized. FCR database
Patient Account Representative/Collector
Community Memorial Hospital
07.2006 - 03.2007
- ER Admitting, Collections on all Bill Types In-patient, Out-patient and Professional
- Ensure claims are paid or denied based on terms of contract
- Receive inbound and place outbound follow up calls on a daily basis to resolve issues for payment
Medical Receptionist
Gary R. Mitnick D.O.
09.2004 - 02.2006
- Responsible for all aspects of Front Office Duties
- Answered telephones, greeted and scheduled patients, surgery scheduling, pull files and prepared charts
- Inputted and updated patient information / Verified all Insurance information (eligibility and co-pay information.) and obtained authorization for procedures/Negotiated and updated provider contracts for all insurance types
- Balanced checks, credit cards and cash payments including posting payments on Medi-soft Medical Database
- Opened and recorded daily correspondence including deposits and posting of insurance payments
Membership Specialist III
Blue Cross of California
09.1999 - 09.2004
- Representative in claims department including keying, processing and adjustment of all claim types (professional, out-patient, and in-patient)
- Worked with Finance department for payment reconciliation from providers for reimbursement of Professional Ob deliveries
- Trained new representatives on customer service calls, claims and navigation on WGS system
- Provide full service to members, providers group administrators by handling inquiries and resolving issues
- Completion of monthly membership reports, which include tape errors, terminations, daily files for all lines of business
- “Four Years Excellent Customer Service, Claims and Membership Experience”
Education
Associate of Science - Behavioral Sciences
Grand Canyon University
Phoenix, AZ08-2028
Skills
- Bilingual-Spanish: Speak, Read, and Write
- ICD-9, HCPC/CPT Codes/ Excellent Medical/Insurance Administrative Backround experience
- Computer Literate in Word, Excel, and Access Programs/Excellent Interpersonal Skills
Languages
Spanish
Full Professional
Timeline
Claims Analyst
Centene
08.2022 - Current
Claims Representative
LifeCare Assurance Company
03.2020 - 07.2022
Customer Service Representative
Aetna Dental
04.2007 - 10.2019
Patient Account Representative/Collector
Community Memorial Hospital
07.2006 - 03.2007
Medical Receptionist
Gary R. Mitnick D.O.
09.2004 - 02.2006
Membership Specialist III
Blue Cross of California
09.1999 - 09.2004
Associate of Science - Behavioral Sciences
Grand Canyon University
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