CLAUDIA VALENZUELA
Youngtown,AZ
Summary
Professional with robust experience in customer service leadership, excelling in team collaboration and achieving results. Adept at managing high-pressure environments, resolving conflicts, and ensuring customer satisfaction. Skilled in coaching staff, optimizing call center operations, and adapting to changing needs. Reliable and focused on driving performance and operational excellence.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Patient Access Services Representative
Banner Health
07.2022 - 10.2022
- Verify patients demographics.
- Verify and demonstrate proper understanding of insurance information and services guidelines and benefits.
- Knowledge with insurances and CMS when reviewing with the patient and obtaining compliance information, consent and documentation required by the patient's insurance plan or CMS.
- Discuss financial and liability information, collection of payments, assisted patients in applying with the Banner line of credit (Curae) setting up payment plans, or assistance with Banner Financial Assistance Policy application
- Update daily reports updating, daily deposits and outstanding balances.
- Covered ER front desk with patient check-in.
Customer Service Supervisor (Member Contact Data Unit)
AHCCCS
08.2014 - 04.2022
- Taking action, and being accountable for answering staff’s questions timely.
- Oversee 15-30 customer service representative agents and analysts, that handle inbound calls from customers, members, providers and Community Assistor's and Switchboard operators.
- Monitor quality, productivity, and performance of staff.
- Monitor the workflow to ensure daily tasks have been completed within the allocated time.
- Train new skills that will enhance staff growth.
- Coaching and developing staff to help meet their daily goals
- Conduct staff meetings, new hire Member Contact and Data Unit training, and work special projects required by management.
- Update eligibility, remove /adding third party insurances, correct eligibility discrepancies and update demographics in PMMIS.
- Monitor the MCDU Member escalation Outlook public folder.
- Complete request submitted by the RBHA, demographic changes, removing/adding alternate ID’s, PMMIS emergency medical postings and creating referrals for multiple IDs and overlays.
- Assist other departments such as Policy with Spanish translations.
- Attend monthly visits with the Vital Stats Office to verify member’s Dates of Death.
- Participated in the development of new training modules for the Member Contact and Data Unit, which teaches the AHCCCS Enrollment policy and procedures.
- Attending management meetings and taking Leadership Through Engagement classes to enhance and prolong my supervisor skills.
- Attending weekly huddle meetings to discuss Member Contact and Data Unit projects and development lean process to meet Arizona Management System.
Administrative Assistant II (Special Detail)
AHCCCS
10.2013 - 08.2014
- Took on the role of our Member Contact Unit trainer, taught over 50 courses to Customer Service Representatives. By preparing training material, coordinating orientation and conducting training to ensure a smooth integration into the team.
- Boosted team productivity by managing communication with representatives by answering questions, handle escalated calls and emails to ensure timely responses to inquiries.
- Complete required reports to help monitor quality, productivity, and the performance of agents and Call Center.
- Managed incoming mail by sorting, scanning, and filing documents into Fortis for the eligibility hearing coordinators.
- Assisted eligibility hearing coordinators with submitting electronic motion requests to the Office of Administrative Hearings and customers.
- Managed calendar scheduling, ensuring timely appointments and effective time management for executives.
- Developed streamlined Web Tool filing systems, improving document retrieval speed, statistics and organization.
Administrative Assistant II (Eligibility Hearings)
AHCCCS
10.2013 - 05.2014
- Managed incoming mail by sorting, scanning, and filing documents into Fortis for the eligibility hearing coordinators.
- Participated in the development of a new hearings Web Tool system, which stores and complies customers hearing information to help generate statistics reports for management.
- Assisted eligibility hearing coordinators with submitting electronic motion requests to the Office of Administrative Hearings and customers.
Customer Service Representative I (Communication Center)
AHCCCS
11.2006 - 10.2013
- Analyze and resolve difficult calls with limited supervision.
- Complete stillborn/newborn request received via email.
- Manage faxes, issuing member denial letters, and quality spot check of referrals.
- Complete enrollment Medical Health Plan changes.
- Conduct new hire Communication Center training to customer service representatives in various policy, procedures, and systems.
- Ensured all tasks have been completed within the allocated period.
- Handled 95-100 inbound calls per day from customers, members and providers who have questions about our AHCCCS programs, their current eligibility or enrollment. Programs include, Kidscare, MA-SP, ALTCS, Medicare, PMMIS and DES.
Customer Service Representative I (MSP)
AHCCCS
02.2005 - 11.2006
- Sorted incoming mail such as; applications, supporting documents, and member’s change requests.
- Scanned and filed documents into Fortis system for the Registration Unit.
- Assisted Medicare Savings Program (MSP) Hotline Unit with in-bound calls.
- Worked on special projects as training and coordinated work tasks, effectively adapting quickly to changing priorities and circumstances due to deadlines with limited supervision.
- Worked as a receptionist assisting the public in applying for MSP benefits, verify the members eligibility and provide application status information.
Education
High School Diploma -
The Alexandria Academy
El Mirage01-2023
Skills
- Microsoft Office Excel, Word, Power Point, Publisher, Outlook, PMMIS, ACE, Health-e-Arizona Plus, AZTECS, Fortis, RightFax, Cognos, Cisco Finesse, Cisco Unified Intelligence Center, Cisco Agent Re-Skilling Tool, Employee Metrics, MS4, ECare, Ecare Next, My Banner Health, Schedule Book, Observation Codes (OBS), Flywire, Curae, Powerchart
Certification
- Certified OSHA 30
- Certified CPR
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Patient Access Services Representative
Banner Health
07.2022 - 10.2022
Customer Service Supervisor (Member Contact Data Unit)
AHCCCS
08.2014 - 04.2022
Administrative Assistant II (Special Detail)
AHCCCS
10.2013 - 08.2014
Administrative Assistant II (Eligibility Hearings)
AHCCCS
10.2013 - 05.2014
Customer Service Representative I (Communication Center)
AHCCCS
11.2006 - 10.2013
Customer Service Representative I (MSP)
AHCCCS
02.2005 - 11.2006
High School Diploma -
The Alexandria Academy