Clarissa Castañeda
Texas,USA
Summary
Health insurance professional with deep understanding of policy management and client relations. Adept at simplifying complex insurance terms and providing intuitive guidance to clients. Known for strong teamwork, adaptability, and effective communication skills.
Overview
2026
2026
years of professional experience
1
1
Certification
Work History
Medicare Health Insurance Agent
Optum -United Healthcare
San Antonio, TX
- Educated individuals on Medicare Advantage, Medicare Supplement, and Prescription Drug Plans while ensuring understanding of coverage options and benefits.
- Maintained compliance with federal and state healthcare regulations, company policies, and CMS guidelines.
- Helped clients navigate enrollment periods and resolve insurance-related questions or concerns efficiently
- Built and maintained strong client relationships through excellent customer service, follow-up communication, and policy support.
- Provided comprehensive customer service to drive client satisfaction.
- Responded to customer inquiries regarding health insurance coverage and policies to assist with informed decision-making.
- Compiled and maintained client records to monitor health insurance policies and premiums paid.
Sales Development Representative (SDR)
Florida Blue (Blue Cross and Blue Shield of Florida)
Texas
05.2023 - 10.2025
- Generated and qualified leads by educating federal employees and union members on health plan options, benefits, and enrollment opportunities
- Explained Medicare, supplemental health plans, and additional coverage options while ensuring compliance with company and federal regulations
- Utilized CRM systems to track leads, manage pipelines, and document customer interactions.
Case Management Specialist
CareFirst BlueCross BlueShield
Edinburg, TX
08.2021 - 05.2023
- Conducted case assessments and maintained detailed documentation in compliance with HIPAA and healthcare regulations.
- Collaborated with healthcare providers, insurance representatives, and multidisciplinary teams to ensure continuity of care.
- Monitored member progress and followed up on medical appointments, prescriptions, and care plans.
- Helped resolve member concerns related to healthcare coverage, claims, authorizations, and service coordination.
- Educated members on preventive care, wellness programs, and available healthcare resources
Medical Claims Specialist
Wellcare Healthcare Plans
02.2020 - 12.2021
- Processed and reviewed medical claims for accuracy, eligibility, and compliance with healthcare policies and procedures.
- Investigated and resolved claim discrepancies, denials, and billing issues while maintaining high levels of customer service.
- Verified patient insurance coverage, benefits, and authorization requirements to ensure timely claim adjudication.
- Communicated with healthcare providers, members, and internal departments regarding claim status and payment resolutions.
Service Contractor
CPS Energy
Dallas, TX
03.2019 - 07.2020
- Utilized technical tools, work orders, and service documentation systems to track completed assignments accurately.
- Performed electric service support and field operations for residential and commercial utility customers.
- Communicated with clients regarding project timelines, service recommendations, and repair needs.
Sales Development Representative - Corporate Gifting
L Brands
Texas
10.2018 - 02.2019
- Maintained detailed records of customer interactions, sales opportunities, and follow-up communications using CRM systems.
- Supported revenue growth by meeting sales targets, upselling products, and providing exceptional customer service
- Assisted clients with product inquiries, pricing, order details, and bulk gifting options
Education
High School Diploma -
Sharyland Pioneer HS
McAllen, TX2018
Skills
- Quality control/ audits training
- Claims negotiation
- Sales
- HIPAA
- Financial acumen
- Policy analysis
Certification
- Certified Floral Designer (CFD) Presented by the School of Benz Floral design
- Costumer service certification (CCSP) January 2018 to Present Completed customer service certification training focused on building professional relations, effective communication, conflict resolution, problem-solving, and customer satisfaction.
- OSHA General Industry Safety and Health April 2018 to April 2027
- Hazardous Waste Operations & Emergency Response Training
Languages
English - Fluent
Spanish - Expert
Timeline
Sales Development Representative (SDR)
Florida Blue (Blue Cross and Blue Shield of Florida)
05.2023 - 10.2025
Case Management Specialist
CareFirst BlueCross BlueShield
08.2021 - 05.2023
Medical Claims Specialist
Wellcare Healthcare Plans
02.2020 - 12.2021
Service Contractor
CPS Energy
03.2019 - 07.2020
Sales Development Representative - Corporate Gifting
L Brands
10.2018 - 02.2019
Medicare Health Insurance Agent
Optum -United Healthcare
High School Diploma -
Sharyland Pioneer HS
Additional Information
Authorized to work in the US for any employer