Denisser Amos
Porter,TX
Summary
Customer service specialist with extensive experience in healthcare insurance. Proven ability to resolve complex issues efficiently while maintaining meticulous documentation. Committed to enhancing service delivery and customer satisfaction through effective problem-solving skills.
Overview
1
1
Certification
13
13
years of professional experience
Work History
Member Service Representative II
Kelsey Care Advantage
Houston, TX
06.2023 - Current
- Ensured positive customer experiences through effective communication and problem-solving skills.
- Recommended appropriate services and products to meet healthcare insurance needs of customers.
- Conducted needs assessments through customer interviews to provide tailored solutions.
- Resolved customer complaints through active listening, addressing issues, and following up for satisfaction.
- Provided customer service support to patients regarding their authorization inquiries.
- Utilized Trizetto for account verification and maintenance, ensuring accurate customer information.
- Processed claims by reviewing documentation and verifying accuracy following Medicare guidelines.
- Compiled timely, accurate reports on accounts and metrics to support decision-making.
- Maintained detailed records of communications to ensure seamless collaboration among customers, claimants, providers, and internal departments.
Licensed Esthetician (Manager)
Jayes Beauty Bar
Houston, TX
12.2019 - 02.2023
- - Increased sales by 10% through tailored product recommendations. Recommending products tailored to clients' skincare needs.
- - Cultivated strong customer relationships through tailored treatment plans and facials addressing individual skin needs.
- - Executed microdermabrasion facials and recommended skincare products, contributing to sales growth.
- - Conducted waxing treatments for hair removal, ensuring client comfort and satisfaction.
- - Maintained a clean and sanitized work environment to ensure client and coworker safety.
- - Instructed refresher courses on eyelash extensions, enhancing team skills and service quality.
- Performed customized facials using advanced skincare techniques and products.
- Educated clients on skincare routines and product usage for optimal results.
Customer Service Representative
Cigna Health
Houston, TX
06.2018 - 12.2021
- Resolved customer complaints through effective communication and problem-solving, improving customer satisfaction and retention.
- - Made outbound calls to providers regarding medical billing inquiries.
- - Scheduled appointments, checked precertification statuses, and resolved claim issues.
- - Researched claims, verified member eligibility, and documented appeals for providers and members.
- Collaborated with insurance adjusters to assess claim validity, influencing timely and accurate claims processing.
- -Adhered to Medicare guidelines during claims processing to ensure compliance.
- Processed high volume of claims, ensuring adherence to quality standards and enhancing overall service effectiveness.
- Reviewed and analyzed trends in claims to identify opportunities for improvement.
Customer Service Representative/ Team Lead
Aetna
Houston, TX
05.2015 - 09.2017
- - Delivered quality customer service by effectively resolving claim issues and processing claims efficiently.
- - Led team meetings to share best practices and clarify expectations for team members.
- - Researched claims and verified member eligibility to ensure accurate documentation of appeals for providers and members.
- -Adhered to Medicare guidelines during claims processing.
Customer Service Representative/ Team Lead
Asurion
Houston, TX
04.2013 - 05.2015
- Led team in delivering exceptional customer service support.
- - Greeted customers, managed conversational flow, and ensured exceptional service experience.
- - Resolved customer complaints and navigated challenging situations with professionalism.
- - Supported team manager and performed management duties in their absence.
- - Created detailed reports on team performance and aligned objectives with departmental goals.
- Trained new representatives on company policies and procedures.
- Managed daily operations to ensure efficient service delivery.
- Identified opportunities for process improvements within the department.
- Analyzed customer feedback surveys to identify areas for improvement within the team.
Education
High School Diploma -
Forest Brook Senior High School
Houston, TX06-2008
Skills
- Customer service
- Claims processing
- Account verification
- Medicare compliance
- Customer relationship management
- CRM software
Certification
- Esthetician License
- TWIC Card
Timeline
Member Service Representative II
Kelsey Care Advantage
06.2023 - Current
Licensed Esthetician (Manager)
Jayes Beauty Bar
12.2019 - 02.2023
Customer Service Representative
Cigna Health
06.2018 - 12.2021
Customer Service Representative/ Team Lead
Aetna
05.2015 - 09.2017
Customer Service Representative/ Team Lead
Asurion
04.2013 - 05.2015
High School Diploma -
Forest Brook Senior High School