Serves as the front-line resolution advocate on various members and/or provider inquiries, requests, or concerns
Resolves basic problems by communicating the requested information regarding the assessment of the member or provider needs, understanding the cause, and determining if issues need to be routed to other departments for further resolution
Provides customer service in a high-paced contact center environment over the phone.
Documents all members or provider information and communications for quality and performance tracking through the Customer Relationship Management (CRM) applications
Remains up-to-date and adheres to quality standards, regulations, and all other policies to ensure quality, consistency, and compliance
DentaQuest/SunLife
Tier 3 Representative
05.2021 - 09.2023
Job overview
Answer 30/50 calls per day
Assist members with Finding a Dentist and scheduling appointments.
Explained Medicare and Medicaid benefits
Review the status of denied Authorizations and Claims
DentaQuest/SunLife
Complaints and Grievances – Triage Specialist
09.2023 - 12.2023
Job overview
Adhered to workflow and processes.
Responsible for turnaround times
Created a manual letter to send to members and providers.
VXI Global Solution
Los Angeles, CA
Account Associate/SME
06.2017 - 09.2020
Job overview
Trained new hires about policy and procedures
Assisting customers with selecting the right package
Retaining customer with loyalty skills
Applying all technical skills to assist customer with issue with their television
Customer Service Advocate at Blue Cross Blue Shield Of Michigan & Blue Care NetworkCustomer Service Advocate at Blue Cross Blue Shield Of Michigan & Blue Care Network