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
Hamilton, NJ
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