Detail-oriented professional with over 13 years of customer service experience. Extremely customer-oriented with excellent problem-solving skills. A willingness and ability to learn new systems and skills. Able to plan, organize, and effectively communicate with others. Known for reliability, dedication and always maintaining a positive work ethic.
Overview
12
12
years of professional experience
Work History
Health Concierge
Aetna, a CVS Health
06.2022 - Current
Filed appeals on behalf of customers, when necessary, after denial of a claim due to insufficient evidence.
Conducted research into medical terminology related to healthcare claims processing activities.
Provided quality customer service to assigned, insured members throughout claims process to deliver timely service to customers.
Answered incoming calls regarding member benefits and services.
Researched complex issues related to accounts or services provided by the organization.
Delivered quality service by assessing, advising, and assisting members.
Resolved complex insurance issues by communicating with providers, patients, and third-party payers.
Communicated regularly with physicians' offices regarding status updates on pending claims or reimbursements.
Ensured compliance with HIPAA regulations when handling sensitive patient information.
Optometric Assistant
Texas State Optical
Lewisville, TX
06.2016 - 01.2018
Administered visual field testing which included visual acuity tests, glaucoma screening, ocular photography, optical coherence tomography and pre-exam data collection and communicated findings to doctor.
Performed clerical duties, such as word processing, data entry, answering phones and filing.
Discussed problems, impairments and corrective lens prescriptions with patients to select proper corrective equipment.
Conducted patient interviews to gather health history and information about current medical issues.
Communicated with patients by phone and via written correspondence.
Scheduled appointments, handled referrals and ordered supplies for optometric practice.
Stocked clinical workstations and procedure rooms with necessary supplies.
Assistant Manager and Sales
At The Beach Tanning
Rancho Santa Margarita, CA
03.2013 - 10.2013
Collaborated with Regional Sales Managers to make strategic sales decisions. Executed updated marketing plans to increase branding exposure, customer traffic and sales.
Assisted team and other stores with sales-processing tasks to meet daily sales goals including working at other locations that needed help meeting those goals and increasing sales by 20%.
Helped customers find specific products, answered questions and offered product advice.
Developed relationships with clients and potential clients to improve business growth.
Supervised and implemented collection of account orders within territory, working closely with operations team to timely ship open orders.
SENIOR MANAGER, NETWORK CONTRACTING at Aetna, a CVS Health Company (First Health Network)SENIOR MANAGER, NETWORK CONTRACTING at Aetna, a CVS Health Company (First Health Network)