Erika Najera
Phoenix,AZ
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
9
9
years of professional experience
Work History
Customer Service Remediation AOP
Wells Fargo AOP-Adecco-Epiq Gobal
11.2023 - Current
- Promoted a positive work environment through open communication channels, fostering team collaboration and high morale.
- Collaborated with other departments to address recurring customer concerns, improving overall service quality.
- Coached employees through day-to-day work and complex problems.
- Improved customer satisfaction by addressing and resolving escalated issues promptly and professionally.
Prior Authorization Representative
CVS HEALTH
07.2022 - 08.2023
- Take incoming calls from doctor offices or hospitals to set a prior authorization on medications for patients.
- Verify patients' accounts for eligibility on the plan.
- Ask the doctor or doctor's office representative questions about the medication requested to verify if the patient qualifies for medication.
- Explain denial reasoning to the doctor's office or conference call with a pharmacist regarding denial clarification.
- Process faxes on prior authorization forms, and emails.
- Review emails for updates on medication changes or new medications on the market.
Prior Authorization Representative
CVS Pharmacy, RANDSTAND
02.2022 - 07.2022
- Verified eligibility and compliance with authorization requirements for service providers.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Tracked referral submission during facilitation of prior authorization issuance.
Customer Service Representative
National General Lender Services
02.2019 - 10.2021
- Handled customer inquiries and suggestions courteously and professionally.
- Actively listened to customers, handled concerns quickly, and escalated major issues to the supervisor.
- Answered a constant flow of customer calls with minimal wait times.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Customer Service Representative Technician
Consumer Cellular
01.2017 - 01.2019
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Investigated and resolved customer inquiries and complaints quickly.
- Exhibited high energy and professionalism when dealing with clients and staff.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Maintained up-to-date knowledge of product and service changes.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
Customer Service Representative
MTBA
10.2015 - 01.2017
- Answered a constant flow of customer calls with minimal wait times.
- Actively listened to customers, handled concerns quickly, and escalated major issues to the supervisor.
- Updated account information to maintain customer records.
- Verification of members' accounts
- Verification on members' doctor appointments
Education
High School Diploma -
South Mountain High School
Phoenix, AZ05.2005
Skills
- Patient Insurance Authorizations
- Strategic Initiatives
- Referral Tracking
- Electronic Patient Medical Record
- Sales
- Technical Support Annalist
Languages
Spanish
Native or Bilingual
Timeline
Customer Service Remediation AOP
Wells Fargo AOP-Adecco-Epiq Gobal
11.2023 - Current
Prior Authorization Representative
CVS HEALTH
07.2022 - 08.2023
Prior Authorization Representative
CVS Pharmacy, RANDSTAND
02.2022 - 07.2022
Customer Service Representative
National General Lender Services
02.2019 - 10.2021
Customer Service Representative Technician
Consumer Cellular
01.2017 - 01.2019
Customer Service Representative
MTBA
10.2015 - 01.2017
High School Diploma -
South Mountain High School
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