Elisea Amaro Sauceda
Stockton,CA
Summary
Results-driven customer service specialist skilled in benefits verification and denial management. Proven ability to streamline communication processes and enhance member satisfaction, leveraging strong rapport-building skills to foster positive relationships within healthcare and medical settings.
Overview
12
12
years of professional experience
Work History
Customer Service Concierge Support Advanced
Blue Shield of CA
Remote CA
01.2021 - Current
- Addressed member inquiries regarding eligibility and benefits to facilitate access to provider information and clinical services.
- Managed correspondence processes for benefits inquiries, providing timely and informative written answers to stakeholders.
- Oversaw the process of updating member records, specifically regarding primary care physician selections.
- Oversaw mid-level inventory reduction initiatives by managing member inquiries and implementing claim adjustments. Coordinated email responses to enhance operational efficiency and member satisfaction.
- Reviewed member claims for precision and provided educational resources on effective benefit application processes.
- Engaged in quality and efficiency workgroups aimed at driving continuous improvements in member and customer satisfaction.
- Facilitated program eligibility assessments, resulting in successful connections to BSC vendors, health advocates, social workers, pharmacy techs, and pharmacists. Achieved member inclusion in outreach or care gap programs, enhancing access to vital services. Promoted member engagement with wellness plan options, fostering improved health outcomes.
- Managed pharmacy call resolutions, focusing on benefits coverage, co-pays, formulary adherence, vacation overrides, and compliance with utilization management standards.
- Enhanced member experience by delivering comprehensive prescription benefit coverage information, including detailed explanations and summaries. Improved understanding of prescription co-pays and formulary coverage through effective communication. Streamlined utilization management processes using web-posted printed formulary. Clarified coverage denial reasons and proposed alternatives from the printed formulary. Resolved prescription claims through effective overrides, ensuring timely access to medications.
- Delivered comprehensive deductible and maximum out-of-pocket information to clients, enhancing their understanding of insurance options. Improved client satisfaction by clarifying complex insurance terms. Streamlined communication processes to ensure accurate information delivery.
- Compiled updates on prior authorization requests to facilitate effective communication with stakeholders.
- Educated members on when and how to effectively appeal coverage decisions to ensure proper resolution.
- Coordinated and delivered required upskill training sessions to ensure workforce readiness for evolving business requirements.
- Other duties as assigned
- Managed scheduling and coordination of patient appointments, optimizing workflow efficiency.
- Facilitated seamless transactions by accurately processing payments, refunds, exchanges, and other account adjustments.
- Collaborated with clinical teams to enhance communication regarding patient care plans and referral processes.
Office Manager
Sportsmans Warehouse
Stockton, CA
01.2015 - 01.2021
- Supervised daily office operations, ensuring efficiency and adherence to company policies.
- Developed and implemented operational procedures to enhance workflow and productivity.
- Managed inventory control systems, optimizing stock levels and reducing waste.
- Trained staff on best practices in customer service and administrative processes.
- Monitored performance metrics, identifying areas for process improvement and cost reduction.
- Developed and implemented employee onboarding programs to enhance retention and engagement.
- Managed employee relations issues, ensuring compliance with labor laws and company policies.
- Maintained company compliance with local, state, and federal laws, in addition to established organizational standards.
- Maintained payroll and benefits for employees in various locations and diminished financial discrepancies through expert program management.
- Managed cash drawer, ensuring balanced accounts at shift end.
- Instructed diverse groups on firearms safety protocols and operational procedures.
- Oversaw daily operations, ensuring optimal store performance and adherence to company policies.
- Conducted regular audits of firearms inventory, identifying discrepancies and implementing corrective actions.
- Collaborated with law enforcement agencies to ensure adherence to regulatory standards during firearm transfers.
- Supervised firearms inventory management processes, ensuring compliance with safety regulations.
Loan Processor
TitleMax Title Loans
Sacramento, CA
04.2014 - 01.2015
- Administered customer accounts with a focus on timely payments and proactive measures to minimize delinquencies.
- Crafted and initiated targeted communication strategies aimed at improving collections outreach effectiveness.
- Evaluated payment trends to detect potential risks and deliver targeted recommendations for process optimization.
- Coordinated with legal teams on account escalations and compliance issues.
- Engaged with delinquent account holders to negotiate settlements, achieving favorable outcomes while reducing overall write-offs.
- Identified underlying issues contributing to delinquent payments and structured re-payment plans to enhance recovery outcomes.
- Assessed loan applications for compliance with regulatory requirements and accuracy to mitigate risk.
- Managed loan pipeline to ensure timely processing and closing of loans.
- Reviewed and assessed financial documentation to ensure compliance with creditworthiness standards.
- Collaborated with other departments including sales, underwriting, legal teams for seamless coordination during the entire loan cycle process.
- Monitored and reviewed updated guidelines to maintain adherence to federal, state, and company regulatory standards.
Education
High School Diploma -
Bear Creek High
Stockton, CASkills
- Scheduling
- Rapport building
- Data Entry
- CRM software
- Genesys software
- Eligibility and benefits verification
- Appeals and denial management
- Medical Billing and Coding
- Health insurance verification
- HIPAA compliance
- Healthcare Termnology
Timeline
Customer Service Concierge Support Advanced
Blue Shield of CA
01.2021 - Current
Office Manager
Sportsmans Warehouse
01.2015 - 01.2021
Loan Processor
TitleMax Title Loans
04.2014 - 01.2015
High School Diploma -
Bear Creek High