Summary
Overview
Work History
Education
Skills
Timeline
Generic

Delia Aguilar

Houston,TX

Summary

Qualified Customer with 12 years in fast-paced customer service and call center environments. Personable and professional under pressure. Hardworking Customer Service Representative with 15 years of experience working with Medical Insurance . Trained in project and time management with extensive knowledge of medical insurance and proven multitasking abilities. Committed to maintaining professional relationships with clients to increase profitability and drive business results.

Overview

15
15
years of professional experience

Work History

Customer Service Representative

Manhattan Life Insurance
Houston, TX
09.2020 - Current
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Achieved and consistently exceeded revenue quota through product and service promotion during routine calls.
  • Evaluated account and service histories to identify trends, using data to mitigate future issues.
  • Offered advice and assistance to customers, paying attention to special needs or wants.
  • Evaluated customer information to explore issues, develop potential solutions and maintain high-quality service.
  • Initiated termination of customer contract upon request.
  • Researched issues through identification of similar past problems and recommended most appropriate solution.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Coordinated with contracting department to resolve payer issues.
  • Tracked all pending authorizations to resolve discrepancies and avoid revenue loss.

Patient Services Representative

Acclara Solutions
Houston, TX
04.2019 - 09.2020
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Answered constant flow of customer calls with up to 45 calls in queue per minute.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Assessed accounts for payment status and reached out to customers.
  • Reviewed and solved account and billing discrepancies.
  • Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
  • Handled high volume of in-bound calls pertaining to reconciliation of delinquent accounts.
  • Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.

Customer Service Associate

Aetna
Houston, TX
10.2006 - 01.2019
  • Greeted customers with enthusiasm and offered immediate and friendly service.
  • Responded promptly to general inquiries from members, staff and clients via mail, e-mail and fax.
  • Trained new employees on company customer service policies and service level standards.
  • Take inbound calls to verify medical benefits.
  • Assist members on authorization status. Provided in network providers for the members.
  • Explain the medical claims.
  • Made outbound calls to providers to find out about services members will be having.
  • Taken escalated calls when a supervisor was not available.
  • Processed medical claims.
  • Worked with claims that needed to be pushed out to be processed.

Education

High School Diploma -

Waltrip High School
Houston, TX

Skills

Customer and Personal Serviceundefined

Timeline

Customer Service Representative

Manhattan Life Insurance
09.2020 - Current

Patient Services Representative

Acclara Solutions
04.2019 - 09.2020

Customer Service Associate

Aetna
10.2006 - 01.2019

High School Diploma -

Waltrip High School

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Delia Aguilar