Eloisa Ramirez
Rosenberg
Summary
Experienced with possible fraud detection, prevention, and resolution. Utilizes analytical skills and attention to detail to identify suspicious activities. Skilled in data analysis, problem-solving, and customer service, with keen eye for identifying possible fraudulent activities. Dependable and efficient, always delivering high-quality outcomes.
Overview
25
25
years of professional experience
Work History
State Call Specialist
Better Business Bureau Education Foundation
09.2023 - Current
- Assisting clients on protecting and detecting Medicare fraud.
- Participated in ongoing professional development opportunities to stay current with industry trends and best practices.
- Utilized SIRS software to manage client interactions, track progress, and maintain accurate records.
- Handled calls while remaining focused on providing outstanding service at all times.
- Contributed to a positive work environment by consistently demonstrating professionalism and teamwork.
- Provided exceptional customer service during the resolution of fraud cases, ensuring a positive experience for affected clients while maintaining company integrity.
- Assisting customers in taking appropriate measures to safeguard their accounts following instances of confirmed or suspected fraud events.
- Analyzed the beneficiary's Medicare statements to identify discrepancies, irregularities and possible fraudulent activity and submit cases to CMS and proper authorities.
Project Management Specialist
DIRECTV
05.2021 - 08.2023
- Creating long- and short-term plans, including setting targets for milestones and adhering to deadlines
- Negotiate and resolve customer conflicts
- Communicating with executives or the board to keep project aligned with company goals
Claims Specialist
Cigna
04.2019 - 04.2021
- Resolved claims disputes, requests for clarification, and appeals in an efficient and timely manner
- Developed a database with medical providers resulting increased quality of service provided to customers
Customer Service Representative
AT&T
03.2000 - 12.2016
- Handled customer inquiries, answered questions, and resolved problems in a timely manner
- Kept accurate records of all interactions, including customer names, addresses, phone numbers, credit card information, and product sales
- Performed sales analytics and provided recommendations that increased sales
Education
Business Management -
University of Phoenix
Houston, Texas05.2009
Skills
- Customer service
- Communication skills
- Computer skills
- Microsoft office
- Bilingual
- Problem-solving skills
- Call center experience
- Teamwork and collaboration
- Multitasking Abilities
- Data entry
- Outbound and inbound calls
- Documentation
Languages
Spanish
Full Professional
Timeline
State Call Specialist
Better Business Bureau Education Foundation
09.2023 - Current
Project Management Specialist
DIRECTV
05.2021 - 08.2023
Claims Specialist
Cigna
04.2019 - 04.2021
Customer Service Representative
AT&T
03.2000 - 12.2016
Business Management -
University of Phoenix
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