Chelsea Ramirez
San Tan Valley ,AZ
Summary
Successful Customer Service Professional with 8 years of experience addressing customer requests and concern via online live chat, emails, and phone. Expert at providing relevant information and options to successfully resolve issues. Upbeat and energetic handling difficult situations through resourcefulness and adaptability.
Overview
5
5
years of professional experience
Work History
Clinical Support Appeal Specialist
Oscar Health
03.2022 - Current
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
- Submitted verbal and written notification to members and providers.
- Entered appeal requests in appeals module.
- Coordinated with other healthcare professionals to provide patients with comprehensive care.
- Reviewed documentation for accuracy and assessment of necessity.
- Proved successful working within tight deadlines and a fast-paced environment.
- Passionate about learning and committed to continual improvement.
- Organized and detail-oriented with a strong work ethic.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified client information by analyzing existing evidence on file.
- Coordinated with contracting department to resolve payer issues.
- Processed appeals received in a timely manner to ensure turnaround times were met.
Customer Service Care Guide
Oscar Health
07.2018 - 08.2022
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
- Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
- Identified, analyzed and researched systemic issues and made recommendations for resolution.
- Provided exceptional customer service to patients, answering questions and addressing concerns.
- Verified insurance eligibility and coverage for patients.
- Filed and maintained patient records in accordance with HIPAA regulations.
- Resolved billing inquiries and disputes in timely fashion.
- Investigated insurance claims denials and appeals.
- Took copayments and compiled daily financial records.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Delivered prompt service to prioritize customer needs.
- Educated customers about billing, payment processing and support policies and procedures.
Education
High School Diploma -
Mcclintock High School
Tempe, AZ05.2015
Skills
- Regulatory Compliance Adherence
- Self Motivated
- Verbal and Written Communication
- Proactive
- Empathetic
- Tech-Savvy
- Problem-Solving
- Critical-Thinking
- Prior Authorization Processing
- Data Entry
- CRM Software
- Problem-Solving Abilities
- 67 WPM
Timeline
Clinical Support Appeal Specialist
Oscar Health
03.2022 - Current
Customer Service Care Guide
Oscar Health
07.2018 - 08.2022
High School Diploma -
Mcclintock High School
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