CLARIBEL FRANCO
Summary
Dynamic customer service professional with over 10 years of experience in problem-solving and assisting clients, fostering strong relationships that benefit both customers and businesses. Proven ability to actively listen and learn from diverse scenarios, leveraging resources effectively to achieve optimal outcomes. A degree in Business Administration with a focus on Marketing enhances the capacity to apply strategic insights and drive results in fast-paced environments. Committed to continuous improvement and delivering exceptional service that aligns with organizational goals.
Overview
26
26
years of professional experience
Work History
Agency Services Representative
DHS Medicaid
05.2022 - Current
- Duty: Assist customer that inquire about Medicaid health insurance, services related to the counties, NJFC, MHC, verification and other services related to Medicare and dual program.
Reimbursement Specialist
Caremetx
12.2021 - 03.2022
- Collects and reviews patient’s insurance benefit information from the payer.
- Resolves any requests in a timely and accurate manner; escalates issues accordingly.
- Maintains frequent phone contact with assigned payers.
- Reports any reimbursement trends/delays to the supervisor.
- Coordinates with inter-departmental associates, as necessary.
- Communicates effectively to payers to ensure accurate and timely benefit investigations.
- Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.
Associate Pick up Dept.
Randstad
11.2020 - 05.2021
Customer Care Rep. II
Incomm / Call Center
04.2017 - 12.2018
- Inbound calls, inquiries regarding transactions processed, cards activation.
- Set up customer account or walk them through.
- First tier level support for technical problem resolution on point-of-use.
- Provide timely, accurate and courteous responses verbally or written and team support.
Claim Assistance / P&C Adjuster
Batista Franco Inc.
04.2008 - 08.2013
- Assist customer with claim in progress (paper work process), policy review.
- Visit workshop, make estimation.
Sale Agent
Universal Insurance Company
08.1999 - 01.2008
- Processing sale transactions as agent representative, managing / updating customer file, work on policy renewal and sale products, collect premium and assist them with claim in progress.
Education
Office Assistance (Survey) Certificate -
San Diego Continuing Education
San Diego01.2016
Bach - Business / Adm
Utesa College: University Technological of Santiago
DR01.2006
Insurance Consultant Certification - undefined
Universal, Insurance Company
12.1999
Skills
- Bilingual (Spanish/English)
- Quick learning
- Computer and office equipment skill
- Verbal communication
- Written communication
- Microsoft Word
- PowerPoint
- Excel
- Outlook
- Laptop
- Desktop Computer
- Fax
- Scanner
- Photo Copy Machine
- Phone: single and multiple lines
Languages
English
Spanish
Timeline
Agency Services Representative
DHS Medicaid
05.2022 - Current
Reimbursement Specialist
Caremetx
12.2021 - 03.2022
Associate Pick up Dept.
Randstad
11.2020 - 05.2021
Customer Care Rep. II
Incomm / Call Center
04.2017 - 12.2018
Claim Assistance / P&C Adjuster
Batista Franco Inc.
04.2008 - 08.2013
Sale Agent
Universal Insurance Company
08.1999 - 01.2008
Bach - Business / Adm
Utesa College: University Technological of Santiago
Insurance Consultant Certification - undefined
Universal, Insurance Company
Office Assistance (Survey) Certificate -
San Diego Continuing Education
Office Equipment
- Laptop
- Desktop Computer
- Fax
- Scanner
- Photo Copy Machine
- Phone: single and multiple lines
Personal Information
Nationality: USA