CRYSTAL CHAVEZ
Miami,US
Summary
With over 8 years of customer service experience and a healthcare background, I'm known for advocating for members and efficiently resolving issues through effective multitasking across various technology platforms. Skilled in collaborating with cross-functional teams, both internal and external, to ensure alignment, drive solutions, and enhance customer satisfaction.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Customer Success Agent (Remote)
Antidote Health
New York, US
07.2022 - Current
- Provide exceptional customer service in compliance with HIPAA guidelines via phone calls, emails, chat, and faxes, addressing inquiries related to members’ coverage, Summary of Benefits, Evidence of Coverage, billing changes, payment collection, member account creation, virtual appointment scheduling, claims processes, technical support, troubleshooting issues, assisting with uploading documentation to patient charts, managing demographic updates, and escalating requests as needed.
- Assist brokers and establish relationships by maintaining direct communication, and providing dedicated support in onboarding, addressing health plan inquiries, managing agency changes, assisting with portal access, appointment statuses, and handling member-related requests.
- Maintain consistent communication with provider offices to ensure members are registered and prepared for appointments, clarify enrollment status, and provide requested documentation, and claims assistance.
- Address grievances and complaints by responding to negative feedback, proactively reaching out to members and patients to resolve issues, escalating internally when necessary, submitting bug reports, and conducting follow-ups to ensure satisfaction and retention.
- Support the medical team with establishing member follow-ups, coordinating with pharmacies, submitting prior authorizations, referrals, lab results, and uploading necessary documentation to patient charts. Provide technical support to clinicians, troubleshoot issues, and update doctors' licenses, credentials, and shifts.
- Contribute to the credentialing process by reviewing flagged provider applications for the medical team.
- Daily collaboration with internal teams (e.g., marketing, engineering, sales, and product) to review updates, releases, campaigns, key implementation needs, and address ongoing projects. Contribute to Spanish translation projects to ensure accurate communication of notices.
- Act as an advocate for members, collaborating with both internal departments and third-party administrators (TPAs) to resolve prescription claims, pharmacy benefits, coverage status, and actively communicate with care management teams to ensure timely and appropriate care for members, acting as a liaison to obtain or provide necessary information.
- Assist in the creation of training materials, and provide training to new agents, ensuring they are equipped to effectively assist members. Participate in recruitment, interviews, and onboarding processes.
- Utilize various systems (e.g., LogRocket, Django, Efax, Salesforce, Monday, Aircall, Slack, Zuora, Dosespot, Teams, Excel, Miramar, Navitus, EMR, Google Sheets, Adobe) to gather information, track, and resolve member and patient needs.
Phone Interpreter (spanish/english)
Transperfect
Miami, US
02.2022 - 05.2022
- Maintained strong retention skills while managing a high volume of inbound calls, averaging 50 to 60 calls per day.
- Provided interpretation services for clients seeking assistance with Medicare and Medicaid, legal services, banking institutions, government programs, social services, housing, utility support, health insurance, collection accounts, and hospitals and medical facilities.
- Provided interpretation for patients during office appointments, helping to translate symptoms and medical conditions, requiring familiarity with medical terminology.
- Utilized systems such as Salesforce, Zendesk, Teams, and Gorgeous to efficiently track and resolve client inquiries.
Remote Customer Service Reservation Agent
Randsdad Logisticare
Miami, US
09.2020 - 01.2022
- Provided assistance and information to members regarding their medical benefits, scheduled transportation services, demographic changes, and escalated or conducted warm transfers to insurance providers when necessary.
- Coordinated real-time communication with members to assist with transportation to and from doctor appointments, ensuring services were provided smoothly, and members were picked up on time.
- Communicated special requests, such as wheelchair accommodations or physical assistance, to transportation agencies for disabled members, ensuring that their needs were met.
- Handled a high volume of inbound calls, maintaining a positive tone, patience, and strong customer service skills, even in situations where members were frustrated, utilizing de-escalation techniques to resolve issues effectively.
- Utilized computer systems to research and record account information, including complaints, address changes, reservation updates, and special service requests.
Group Home Staff Member
Mugica Group Homes
Miami, US
05.2017 - 08.2020
- Collaborated closely with case managers, social workers, the Agency for Persons with Disabilities (APD), referral coordinators, and community groups to facilitate the enrollment of group home members in educational programs, speech therapy, job opportunities, and clubs, ensuring seamless access to essential services, and the appropriate support for each member.
- Logged information on daily medication intake, patient charts, blood pressure, behavior, and activity levels of children and elderly residents in the group home.
- Scheduled appointments and attended meetings to support ongoing care and coordination.
- Developed and implemented engagement activities to build socialization skills, creativity, health, and stimulation.te health, and provide mental stimulation.
Education
Some College (No Degree) - Kinesiology
Florida International University
Miami, FLSome College (No Degree) -
Miami Southridge Senior High School
Miami, FLSkills
- CRM software experience
- Technical support
- Provider relations
- Medical terminology
- Client outreach
- Client advocacy and relationship-building
- Time management proficiency
- Team collaboration and leadership skills
- Multitasking capacity
- Excellent verbal and written communication
- Adaptability and flexibility
- Appointment scheduling
- Schedule management
- KPIs
- Project management
- Account management
- Problem-solving
- Service coordination
- Data entry and retention
- Referral management
- Organizational skills
- Pharmacy benefit management
- Prior authorization process
- Claim research
- Maintaining HIPAA guidelines and patient confidentiality compliance
Certification
- BLS certified
- Licensed Insurance Agent
Languages
Spanish
Native/ Bilingual
Timeline
Customer Success Agent (Remote)
Antidote Health
07.2022 - Current
Phone Interpreter (spanish/english)
Transperfect
02.2022 - 05.2022
Remote Customer Service Reservation Agent
Randsdad Logisticare
09.2020 - 01.2022
Group Home Staff Member
Mugica Group Homes
05.2017 - 08.2020
Some College (No Degree) - Kinesiology
Florida International University
Some College (No Degree) -
Miami Southridge Senior High School
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