Esmeralda Esparza
Las Vegas
Summary
Accomplished advocate with a strong background in provider services, offering a proven track record in resolving provider inquiries and ensuring seamless communication between providers and healthcare organizations. Skilled in leveraging problem-solving and communication expertise to improve provider satisfaction and drive operational efficiency.
Overview
3
3
years of professional experience
Work History
Provider Service Advocate
United Healthcare
11.2022 - Current
- Manage incoming calls, via chats, and inquiries from healthcare providers in doctors' offices.
- Bring extensive provider service experience to the role, ensuring efficient and effective resolution of inquiries.
- Proficient in computer systems and Windows PC applications, with experience using Microsoft Office programs.
- Provide providers with detailed explanations regarding benefits, eligibility, and claims.
- Knowledgeable in various plan types, including Medicare, Retirement plans, and commercial policies.
- Experienced in submitting authorizations for pre-service procedures.
- Identify claims requiring re-processing to ensure accurate denial management.
Customer Service Representative
PennyMac Loan Services
07.2021 - 11.2022
- Manage incoming calls and inquiries from prospective customers or clients, providing exceptional service and support.
- Bring extensive customer service experience, particularly in the home mortgage sector.
- Achieve sales objectives through strategic account management and a strong focus on customer satisfaction.
- Complete necessary paperwork and data entry to support customer needs and ensure accurate records.
- Trained in conducting audits to prepare for state requirements and regulatory compliance.
Education
Associate of Arts - Social Work
College of Southern Nevada
Las Vegas, NV07-2018
High School Diploma -
Valley High School
Las Vegas, NV06-2016
Skills
- In-depth knowledge of Medicare, Commercial, People's health and related healthcare programs
- Claims re-processing
- Extensive call center experience
- Insurance verification
- Provider relations
- Exceptional customer service skills
- Problem solving
- Management skills
- Reliable
Timeline
Provider Service Advocate
United Healthcare
11.2022 - Current
Customer Service Representative
PennyMac Loan Services
07.2021 - 11.2022
Associate of Arts - Social Work
College of Southern Nevada
High School Diploma -
Valley High School
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