Erika Lomas
Los Angeles,CA
Summary
Resourceful employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Utilization Management Representative II
Elevance Health
Cerritos, CA
11.2023 - Current
- Manage incoming calls or post services claims work
- Determine contract and benefit eligibility
- Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
- Obtain intake (demographic) information from caller
- Conduct a thorough radius search in Provider Finder and follow up with provider on referrals given
- Refers cases requiring clinical review to a nurse reviewer; handle referrals for specialty care
- Process incoming requests, collect the information needed for review from providers, and utilize scripts to screen basic and complex requests for precertification and/or prior authorization.
- Verify benefits and/or eligibility information.
- May act as a liaison between Medical Management and internal departments.
- Respond to telephone and written inquiries from clients, providers, and in-house departments.
- Conduct clinical screening process
Customer Service Representative
Molina Healthcare
Long Beach, CA
07.2021 - 11.2023
- Supports inbound and sometimes makes outbound phone calls from members or providers on routine or simple issues.
- Accurately documents all member calls.
- Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in a respectful and timely manner).
- Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests, and identify the member or provider’s needs.
- Achieves individual performance goals established for this position in the areas of, call quality, attendance, schedule adherence and individual performance goals as it relates to call center objectives.
- Demonstrates personal responsibility and accountability by taking ownership of the call and following it through to resolution, on behalf of the customer, in real time or through timely follow up with the member and/or provider to escalate issues based on established risk criteria.
- Responds to and resolve the customers inquiries by identifying the topic and type of assistance the caller needs such as assistance involving their eligibility, ID cards, Member Portal, PCP changes, and personal information updates etc.
- Proactively engages and collaborates with other departments as required.
- Provides status of submitted claims.
PBX Operator
Teksystems, MemorialCare Medical Center
Long Beach, CA
09.2017 - 06.2021
- Multitask utilizing double monitors, phone etiquette and use of resources while maintaining proper guidelines.
- Assists with emergencies (fire and medical) systems by contacting the designated personnel for immediate assistance.
- Organize and distribute reports, correspondence, mail etc.
- Effectively answer and transfer 1000 calls per day at 99% accuracy rate to appropriate departments while simultaneously operating paging systems to communicate with medical staff during emergency services.
- Communicate clearly and professionally with callers, patients and staff members to ensure high standards of satisfaction, loyalty and retention.
- Create and distribute vital on call physical and technician schedules.
- Perform a variety of routine clerical duties while maintaining a high sense of confidentiality.
Unit Clerk
Sodexo, MemorialCare Medical Center
Long Beach, CA
04.2008 - 09.2018
- Answered, screened and transferred telephone calls.
- Maintained records, forms, and verified information to resolve routine problems.
- Opened and routed incoming mail, answered correspondence, and prepare outgoing mail.
- Executed additional duties as assigned.
Education
High School Diploma -
Compton Adult School
ComptonSkills
- Customer Service-oriented
- Bilingual (Spanish & English)
- Ability to maintain composure in a challenging situation
- Ability to demonstrate active listening skills
- Knowledge in Microsoft Office
- Knowledge in Excel
- Knowledge in Word
- Knowledge in Outlook
- Knowledge in Providerone
- Knowledge in AEVS
- Knowledge in New Century Health
- Knowledge in CVS Caremark
- Knowledge in Salesforce
- Knowledge in Verint
- Knowledge in Kronos
- Knowledge in Microsoft Teams
- Knowledge in UM PEGA AUTH look up tool
- Knowledge of some medical terminology
- Capable of working independently as required
- Multi-line telephone experience
Certification
- Nursing Assistant, 01/01/09
- Administrative Assistant, 05/01/12
Timeline
Utilization Management Representative II
Elevance Health
11.2023 - Current
Customer Service Representative
Molina Healthcare
07.2021 - 11.2023
PBX Operator
Teksystems, MemorialCare Medical Center
09.2017 - 06.2021
Unit Clerk
Sodexo, MemorialCare Medical Center
04.2008 - 09.2018
High School Diploma -
Compton Adult School